Excessive daytime sleepiness is associated with incident heart failure in a clinical population with obstructive sleep apnea

SESSION TITLE: Sleep Disorders Posters 2 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: The relationship between excessive daytime sleepiness (EDS) and incident heart failure (HF) has rarely been studied. Thus, we conducted this analysis to determine the temporal association between EDS and incident HF in a clinical population with obstructive sleep apnea (OSA). METHODS: The data was obtained from 310 individuals with OSA diagnosed by either a home sleep apnea test or an in-lab polysomnogram and had a cardiac PET stress test between 2015 to 2019. Sleep and cardiac tests were done for clinical indications such as snoring (sleep tests) and angina (stress tests). Prior to the sleep test, the patients completed the Epworth Sleepiness Scale (ESS) questionnaire. Severe obstruction was defined as an apnea hypopnea index or respiratory event index (both referred to as AHI) ≥ 30/hr. Hypoxia was defined by the percentage of sleep or monitored time with oxygen saturation below 90% (T90) ≥ 9% while EDS was defined an ESS score ≥10. Incident HF was defined as an index hospitalization for a HF diagnosis in persons without a history of HF. Outcome adjudication was conducted up to June 2022, up to 8.5 years. RESULTS: The mean age (SD) of the patients was 60 (11) years, 58% were female and the median BMI was 39.4 kg/m2. There was a weak but significant correlation between ESS and the AHI (r=0.17, P=0.003) and T90 (r = 0.16, p = 0.004). Over 1,265 person-years of risk, there were 39 index HF admissions. After adjusting for age, sex, BMI, race, baseline cigarette smoking, history of hypertension, diabetes, hyperlipidemia, prior myocardial infarction/revascularization, and stroke, EDS was associated with an increased risk of incident HF [adjusted hazard ratio (aHR) 2.0; 95% CI: 1.0 – 3.9]. Further adjustment for the presence of severe obstruction, hypoxia and type of sleep study did not significantly alter the strength or significance of the association. Neither did additional adjustment for stress test parameters such as stress and rest ejection fraction, burden of coronary artery calcification, the presence of abnormal perfusion and the myocardial flow reserve alter the strength or significance of the association. CONCLUSIONS: EDS is associated with increased the risk of incident HF in this clinical population with OSA independent of possible confounders, severity of OSA or coronary perfusion abnormalities. Larger studies will be needed to understand the impact of treating EDS in OSA on heart failure risk. CLINICAL IMPLICATIONS: Among persons with OSA, the presence of EDS identifies individuals at elevated risk of heart failure. Thus, EDS may be useful in heart failure risk assessment in this population. DISCLOSURES: No relevant relationships by Ehimen Aneni No disclosure on file for Atilla Feher No relevant relationships by Olaoluwatomi Lamikanra No relevant relationships by Kenechukwu Mezue No relevant relationships by Isaac Ogunmola No relevant relationships by Chukwuemeka Osondu No relevant relationships by Fadar Otite No relevant relationships by Gul Saeed No disclosure on file for Henry Yaggi