Sleep apnea predicts cardiovascular death in patients with Marfan syndrome:a cohort study
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Sleep apnea predicts cardiovascular death in patients with Marfan syndrome:a cohort study. / Gessler, Nele; Wohlmuth, Peter; Anwar, Omar; Debus, Eike Sebastian; Eickholt, Christian; Gunawardene, Melanie A; Hakmi, Samer; Heitmann, Kathrin; Rybczynski, Meike; Schueler, Helke; Sheikhzadeh, Sara; Tigges, Eike; Wiest, Gunther H; Willems, Stephan; Adam, Ekaterina; von Kodolitsch, Yskert.
In: EPMA J, Vol. 13, No. 3, 09.2022, p. 451-460.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Sleep apnea predicts cardiovascular death in patients with Marfan syndrome:a cohort study
AU - Gessler, Nele
AU - Wohlmuth, Peter
AU - Anwar, Omar
AU - Debus, Eike Sebastian
AU - Eickholt, Christian
AU - Gunawardene, Melanie A
AU - Hakmi, Samer
AU - Heitmann, Kathrin
AU - Rybczynski, Meike
AU - Schueler, Helke
AU - Sheikhzadeh, Sara
AU - Tigges, Eike
AU - Wiest, Gunther H
AU - Willems, Stephan
AU - Adam, Ekaterina
AU - von Kodolitsch, Yskert
N1 - © The Author(s) 2022.
PY - 2022/9
Y1 - 2022/9
N2 - BACKGROUND: Surgical replacement of the aortic root is the only intervention that can prevent aortic dissection and cardiovascular death in Marfan syndrome (MFS). However, in some individuals, MFS also causes sleep apnea. If sleep apnea predicts cardiovascular death, a new target for predictive, preventive, and personalized medicine (PPPM) may emerge for those individuals with MFS who have sleep apnea.METHODS: This is an investigator-initiated study with long-term follow-up data of 105 individuals with MFS. All individuals were screened for sleep apnea regardless of symptoms. Cardiovascular death served as a primary endpoint, and aortic events as a secondary outcome.RESULTS: Sleep apnea with an apnea-hypopnea index (AHI) > 5/h was observed in 21.0% (22/105) with mild sleep apnea in 13% (14/105) and moderate to severe sleep apnea in 7.6% (8/105). After a median follow-up of 7.76 years (interquartile range: 6.84, 8.41), 10% (10/105) had died, with cardiovascular cause of death in 80% (8/10). After adjusting for age and body mass index (BMI), the AHI score emerged as an independent risk factor for cardiovascular death (hazard ratio 1.712, 95% confidence interval [1.061-2.761], p = 0.0276). The secondary outcome of aortic events occurred in 33% (35/105). There was no effect of the AHI score on aortic events after adjusting for age and BMI (hazard ratio 0.965, 95% confidence interval [0.617-1.509]), possibly due to a high number of patients with prior aortic surgery.INTERPRETATION: Sleep apnea is emerging as an independent predictor of cardiovascular death in MFS. It seems mandatory to screen all individuals with MFS for sleep apnea and to include these individuals, with both MFS and sleep apnea, in further studies to evaluate the impact of preventive measures with regard to cardiovascular death.SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13167-022-00291-4.
AB - BACKGROUND: Surgical replacement of the aortic root is the only intervention that can prevent aortic dissection and cardiovascular death in Marfan syndrome (MFS). However, in some individuals, MFS also causes sleep apnea. If sleep apnea predicts cardiovascular death, a new target for predictive, preventive, and personalized medicine (PPPM) may emerge for those individuals with MFS who have sleep apnea.METHODS: This is an investigator-initiated study with long-term follow-up data of 105 individuals with MFS. All individuals were screened for sleep apnea regardless of symptoms. Cardiovascular death served as a primary endpoint, and aortic events as a secondary outcome.RESULTS: Sleep apnea with an apnea-hypopnea index (AHI) > 5/h was observed in 21.0% (22/105) with mild sleep apnea in 13% (14/105) and moderate to severe sleep apnea in 7.6% (8/105). After a median follow-up of 7.76 years (interquartile range: 6.84, 8.41), 10% (10/105) had died, with cardiovascular cause of death in 80% (8/10). After adjusting for age and body mass index (BMI), the AHI score emerged as an independent risk factor for cardiovascular death (hazard ratio 1.712, 95% confidence interval [1.061-2.761], p = 0.0276). The secondary outcome of aortic events occurred in 33% (35/105). There was no effect of the AHI score on aortic events after adjusting for age and BMI (hazard ratio 0.965, 95% confidence interval [0.617-1.509]), possibly due to a high number of patients with prior aortic surgery.INTERPRETATION: Sleep apnea is emerging as an independent predictor of cardiovascular death in MFS. It seems mandatory to screen all individuals with MFS for sleep apnea and to include these individuals, with both MFS and sleep apnea, in further studies to evaluate the impact of preventive measures with regard to cardiovascular death.SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13167-022-00291-4.
U2 - 10.1007/s13167-022-00291-4
DO - 10.1007/s13167-022-00291-4
M3 - SCORING: Journal article
C2 - 36061830
VL - 13
SP - 451
EP - 460
IS - 3
ER -
