Association of sleep apnea with outcomes in peripheral artery disease: Insights from the PORTRAIT study.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2021
2021
Historique:
received:
07
04
2021
accepted:
18
08
2021
entrez:
10
9
2021
pubmed:
11
9
2021
medline:
19
11
2021
Statut:
epublish
Résumé
Sleep apnea is a predictor of adverse cardiovascular outcome in many cardiovascular diseases but whether it is associated with worse health status outcomes or mortality in peripheral artery disease (PAD) is unknown. PORTRAIT is an international (US, Netherlands, Australia) prospective PAD registry that consecutively enrolled patients who presented with new-onset or recent exacerbations of PAD symptoms to any of 16 vascular specialty clinics. Health status was assessed upon presentation and at 12 months with the disease-specific Peripheral Artery Questionnaire (PAQ). Higher PAQ scores indicate better health status. A sequentially-adjusted hierarchical linear regression model examined the association between sleep apnea and 1-year PAQ symptoms, quality of life, and summary scores. Five-year survival curves by comorbid sleep apnea status for US patients were compared using the log-rank test. The mean age of the 1204 PORTRAIT participants was 67.6 ± 9.4 years with 37.5% women and 8.3% (n = 100) having sleep apnea. Patients with sleep apnea were more likely to be from the US, more sedentary, and to have diabetes, obesity, coronary disease, more depressive symptoms and a history of prior peripheral interventions. Paradoxically, they also had higher ankle-brachial indices, but lower PAQ Summary scores at presentation and 12 months (41.2 ± 22.0 vs. 49. 9± 21.6 and 58.6 ± 27.9 vs. 71.3 ± 24.9, respectively, p = <0.05). The association between sleep apnea and 1-year health status persisted after multivariable adjustment, but there were no differences in all-cause mortality over 5 years (28.0% vs. 23.4%, p = 0.76). In patients presenting with PAD, comorbid sleep apnea is independently associated with worse health status over time. Future studies should test whether better treatment of sleep apnea can improve the health status of patients with PAD. NCT01419080.
Sections du résumé
BACKGROUND
Sleep apnea is a predictor of adverse cardiovascular outcome in many cardiovascular diseases but whether it is associated with worse health status outcomes or mortality in peripheral artery disease (PAD) is unknown.
METHODS
PORTRAIT is an international (US, Netherlands, Australia) prospective PAD registry that consecutively enrolled patients who presented with new-onset or recent exacerbations of PAD symptoms to any of 16 vascular specialty clinics. Health status was assessed upon presentation and at 12 months with the disease-specific Peripheral Artery Questionnaire (PAQ). Higher PAQ scores indicate better health status. A sequentially-adjusted hierarchical linear regression model examined the association between sleep apnea and 1-year PAQ symptoms, quality of life, and summary scores. Five-year survival curves by comorbid sleep apnea status for US patients were compared using the log-rank test.
RESULTS
The mean age of the 1204 PORTRAIT participants was 67.6 ± 9.4 years with 37.5% women and 8.3% (n = 100) having sleep apnea. Patients with sleep apnea were more likely to be from the US, more sedentary, and to have diabetes, obesity, coronary disease, more depressive symptoms and a history of prior peripheral interventions. Paradoxically, they also had higher ankle-brachial indices, but lower PAQ Summary scores at presentation and 12 months (41.2 ± 22.0 vs. 49. 9± 21.6 and 58.6 ± 27.9 vs. 71.3 ± 24.9, respectively, p = <0.05). The association between sleep apnea and 1-year health status persisted after multivariable adjustment, but there were no differences in all-cause mortality over 5 years (28.0% vs. 23.4%, p = 0.76).
CONCLUSION
In patients presenting with PAD, comorbid sleep apnea is independently associated with worse health status over time. Future studies should test whether better treatment of sleep apnea can improve the health status of patients with PAD.
CLINICAL TRIAL REGISTRATION
NCT01419080.
Identifiants
pubmed: 34506511
doi: 10.1371/journal.pone.0256933
pii: PONE-D-21-11479
pmc: PMC8432750
doi:
Banques de données
ClinicalTrials.gov
['NCT01419080']
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0256933Subventions
Organisme : NHLBI NIH HHS
ID : T32 HL007950
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
Déclaration de conflit d'intérêts
Dr. Smolderen is supported by an unrestricted research grant from Merck, Boston Scientific, Abbott Vascular and Terumo, and she is a consultant for Optum Labs. Dr. Spertus provides consultative services to Amgen, Merck, AstraZeneca, Novartis, Bayer, Janssen and United Healthcare. He has an equity interest in Health Outcomes Sciences and serves on the Board of Blue Cross Blue Shield of Kansas City. He owns the copyright to the Peripheral Artery Questionnaire, the Seattle Angina Questionnaire and the Kansas City Cardiomyopathy Questionnaire. Dr. Mena-Hurtado is a consultant for Bard, Cook, Medtronic, Abbott, Boston Scientific and Cardinal Health. Other authors report no disclosure.
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