Abstract 2876: Severity of Sleep Apnea is an Independent Predictor of Mortality in Patients with Ischemic Heart Disease
Background Several studies have reported worsening mortality in heart failure patients with sleep apnea. However, the burden of sleep apnea in patients with ischemic heart disease is unknown. Our objective was to determine whether severity of sleep apnea is associated with increased mortality in patients with ischemic heart disease. Methods We performed a retrospective cohort study of 300 consecutive patients with a diagnosis of ischemic heart disease who underwent a polysomnography study followed by echocardiography. We compared survival following the echocardiogram between those with severe sleep apnea (severe SA) (AHI ≥ 30/h) and those with mild to moderate sleep apnea (mild-moderate SA) (AHI > 5 and < 30). Results Of the 300 patients (mean age 65 years, mean BMI 34, 98% male, 58% with diabetes), 151 patients had mild-moderate SA and 149 had severe SA. During a mean follow up of 3.2 years, there were significantly greater deaths (Figure⇓) in the severe SA group than mild-moderate SA group (54 deaths (36%) in severe SA vs. 32 deaths (21%) in moderate SA, p = 0.028). The adjusted hazards ratio for mortality with severe SA was 3.60 (CI 1.82–7.23, p < 0.001), and remained significant after excluding patients with LV ejection fraction less than 40% (adjusted HR 2.60, CI 1.16 –5.81, p = 0.02). There was no significant association between the AHI score and echocardiographic measurements, including estimated pulmonary pressure, ejection fraction and mitral regurgitation. Conclusions In patients with ischemic heart disease, the severity of sleep apnea is strongly associated with the risk of death independent of patient and echocardiographic characteristics.