Neomi Shah, MD, MPH: Cardiovascular Risk Concerns in Sleep Apnea


Why are major adverse cardiovascular events not treated as the concern risk factors they are in patients with obstructive sleep apnea?

New findings presented at the American Thoracic Society (ATS) 2019 International Meeting in Dallas, TX, this week showed that varying forms of sleep apnea severity are associated with equally varying risks for acute myocardial infarction.

Though the specific outcomes of the small patient population trial call for lengthier, larger follow-up assessments, the broad finding of an association between a major adverse cardiovascular event and sleep apnea is nothing new to study author Neomi Shah, MD, MPH.

Shah, the associate division chief of Pulmonary Critical Care & Sleep Medicine at Mount Sinai, talked with MD Magazine® while at ATS 2019 to define the currently-understood state of sleep condition-cardiovascular risk overlap.

MD Mag: Does there need to be more awareness raised to cardiovascular event risks associated with sleep apnea?

Shah: Absolutely. I mean, I think that sleep apnea for the last 2 decades has been a well-established independent risk factor for cardiovascular disease, and we've done many, many studies that have shown that sleep apnea is an independent risk factor for stroke, for arrhythmias, for sudden cardiac death, for atrial fibrillation, for myocardial infarction.

But unfortunately, in the recent few years, the clinical trials in that we're trying to treat the sleep apnea condition with continuous positive airway pressure (CPAP), therapy did not reduce the occurrence of some of these events.

So it's a little puzzling, because we've shown that it is a risk factor for cardiovascular disease, but when we treated, it didn't really make the impact that we were hoping for it to make. We're in a state of a little bit of confusion, and we're really trying to dig deep in terms of the mechanisms—as to what it is about the obstructive sleep apnea that was causing this increased risk factor. I think the awareness is there. It may not be as prominent as it is for diabetes, but I think it has been well-known.

But currently, we are a little bit perplexed because of these data from clinical trials. It's not really confirming what we thought should have been the case, and so that's where we're at right now. Clearly, there is a connection. It's just not clear as to how much the degree of sleep apnea severity—as my work has shown—the duration how long you’ve been having sleep apnea that's been undiagnosed, and all of the other comorbidities.

Obesity is a bigger driver of some of these events—and if you are not obese and you have sleep apnea, ‘do we need to treat you’ is a question that we don't really know the answer to.

The study, "Sleep Apnea Severity, Myocardial Infarct Size on Magnetic Resonance Imaging and Coronary Collaterals in ST-Elevation Myocardial Infarction: A Multidisciplinary Study," was presented at ATS 2019.

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