Rationale: Data from population-based cohorts suggest that symptom subtypes and obstructive sleep apnea (OSA)-specific hypoxic burden (HB) could help to better identify patients with OSA at high cardiovascular (CV) risk. Objectives: We aimed to evaluate whether those new markers are associated with the risk of major adverse CV events (MACE) in clinical setting. Methods: Data from the Pays de la Loire cohort were linked to health administrative data to identify the occurrence of MACE (a composite outcome including all-cause mortality, acute myocardial infarction, stroke, and unplanned coronary revascularization) in patients with newly diagnosed OSA and no overt CV disease. Latent class analysis was used to identify subtypes based on eight clinically relevant variables. HB was defined as the total area under the respiratory event-related desaturation curve. Cox proportional hazards models were used to evaluate the association of symptom subtypes and HB with MACE. Measurements and Main Results: Four symptom subtypes were identified (minimally symptomatic [22.0%], disturbed sleep [17.5%], excessively sleepy [49.8%], and moderately sleepy [10.6%]). After a median follow-up of 78 months (interquartile range, 52-109), 592 (11.05%) of 5,358 patients experienced MACE. In a fully adjusted model, HB and overall nocturnal hypoxemia assessed by sleep time with oxygen saturation <90% were the only predictors of MACE (hazard ratio, 1.21; 95% confidence interval, 1.07-1.38; and hazard ratio, 1.34; 95% confidence interval, 1.16-1.55, respectively). The association appeared stronger toward younger patients and women. Conclusion: In clinical setting, patients with OSA who demonstrate elevated OSA-specific HB are at higher risk of a CV event and all-cause mortality. Symptom subtypes were not associated with MACE after adjustment for confounders.

中文翻译：

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睡眠呼吸暂停特异性缺氧负担、症状亚型以及心血管事件和全因死亡率的风险。

理由：来自基于人群的队列数据表明，症状亚型和阻塞性睡眠呼吸暂停 (OSA) 特异性缺氧负荷 (HB) 有助于更好地识别具有高心血管 (CV) 风险的 OSA 患者。目的：我们旨在评估这些新标志物是否与临床环境中主要不良心血管事件 (MACE) 的风险相关。方法：来自 Pays de la Loire 队列的数据与健康管理数据相关联，以确定新诊断 OSA 和没有明显的心血管疾病。潜在类别分析用于根据八个临床相关变量识别亚型。HB 定义为呼吸事件相关去饱和曲线下的总面积。Cox 比例风险模型用于评估症状亚型和 HB 与 MACE 的关联。测量和主要结果：确定了四种症状亚型（症状轻微 [22.0%]、睡眠不安 [17.5%]、过度嗜睡 [49.8%] 和中度嗜睡 [10.6%]）。在中位随访 78 个月（四分位距，52-109）后，5,358 名患者中有 592 名（11.05%）出现了 MACE。在完全调整的模型中，血氧饱和度 <90% 的睡眠时间评估的 HB 和整体夜间低氧血症是 MACE 的唯一预测因子​​（风险比，1.21；95% 置信区间，1.07-1.38；风险比，1.34；95%置信区间，分别为 1.16-1.55）。对于年轻患者和女性，这种关联似乎更强。结论：在临床环境中，OSA 特异性 HB 升高的 OSA 患者发生 CV 事件和全因死亡的风险更高。在调整混杂因素后，症状亚型与 MACE 无关。