Journal Article

0574 A Composite Model of Commonly Derived Polysomnographic Variables Predicts Risk of Cardiovascular Outcomes Better than the Apnea Hypopnea Index Alone

V Trivedi, A Zinchuk, L Qin, D M Bravata, K P Strohl, B J Selim and H K Yaggi


Published on behalf of American Academy of Sleep Medicine

Volume 41, issue suppl_1, pages A213-A214
ISSN: 0161-8105
Published online April 2018 | e-ISSN: 1550-9109 | DOI:

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  • Neurology
  • Sleep Medicine
  • Clinical Neuroscience
  • Neuroscience


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The apnea hypopnea index (AHI) may not be the optimal predictor of OSA-related morbidity, as health outcomes may be related to sleep apnea through distinct pathophysiologic pathways (e.g., hypoxemia, sleep fragmentation). Multiple sleep-associated polysomnographic measures (as opposed to a single index) may be used to better predict outcomes. We aimed to develop a model using polysomnographically (PSG) derived variables that can help identify patients at risk for adverse cardiovascular outcomes or death.


We performed longitudinal analysis of a multi-site observational cohort study conducted at three Veterans Affairs centers (West Haven, CT; Indianapolis, IN; Cleveland, OH). Associations between PSG-derived indices representing four pathophysiological domains of OSA’s impact on cardiovascular disease (sleep architecture disturbance, autonomic dysregulation, breathing disturbance and hypoxemia) and primary outcome (composite of incident stroke, transient ischemic attack, acute coronary syndrome or death) were assessed using logistic regression. Variables associated with cardiovascular outcomes (p<0.20) on bivariate analyses were included in backwards, multivariate logistic regression and a parsimonious model was derived.


We included 1,579 veterans, predominantly men (95%) with mean age of 58 ± 12 years and mean follow-up of 5.5 ± 1.3 years. After adjustment for CPAP use, sleep efficiency ≥ 80% [OR 0.39 (0.24 - 0.63) p < 0.001] was associated with lower risk of primary outcome, whereas percent of total sleep time with SaO2 < 90% [OR: 1.64 (1.26 - 2.15) p = 0.0003], percent REM sleep ≥ 30 [OR: 2.77 (1.07 - 7.19) p = 0.014] and hypopnea index ≥ 5 [OR (95% CI): 1.80 (1.15 - 2.81) p = 0.010] were associated with higher risk of primary outcome. This parsimonious model exhibited better prediction of the primary outcome than traditional clinical cut points of AHI alone (AUC 0.64 versus 0.55).


In our cohort, a composite model containing measures of hypoxemia, sleep efficiency and percent REM sleep is more predictive of adverse cardiovascular outcomes or death than clinical categories of AHI alone.

Support (If Any)

NHLBIK24 (Yaggi PI) CSR&D Merit Review (Yaggi PI).

Journal Article.  0 words. 

Subjects: Neurology ; Sleep Medicine ; Clinical Neuroscience ; Neuroscience

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