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Mini K. Das, MD
Credit: Baptist Health
A new study found that the prevalence of sleep apnea in cardiology patients was high and had similar rates in patients with heart failure with reduced ejection fraction (HFpEF) or heart failure with preserved ejection fraction (HFrEF), and the prevalence of sleep apnea in cardiological patients. cancer patients was equal to or greater than other risk factors used in the risk factor profiling algorithms.1
“Sleep apnea has not been routinely evaluated in patients undergoing cancer therapies,” wrote the researchers, led by Mini K. Das, MD, medical director of the cardio-oncology program at Baptist Health in Louisville, Kentucky. . “In our study, it is as frequent as other traditional risk factors currently used in [cardiovascular] risk algorithms.
Measurements of left ventricular ejection fraction (LVEF), which assesses how well the heart pumps blood throughout the body, and LV global longitudinal strain (GLS), which assesses how much the cell contracts to create a force to expel blood out of the heart. —Both help predict early cardiomyopathy related to cancer therapy. Risk factors may also predict poor cardiovascular outcomes. A 2022 study found severe sleep apnea in heart failure patients and they were 2 to 3 times more likely to experience atrial fibrillation.2
Since sleep apnea causes LV dysfunction, congestive heart failure, and abnormal GLS, researchers wanted to evaluate the prevalence of sleep apnea in cardiology and cardio-oncology patients.1
“Echocardiography has evolved into a useful tool for detecting and therefore treating cardiomyopathy early in patients with sleep apnea and in the cardio-oncology population, so we also wanted to see if there are shared ultrasound markers that identify to patients who are at highest risk as they begin their journey to treat their cancer,” Das said in a news release.
The study included 296 general cardiology patients and 240 cardio-oncology patients. The team obtained data on traditional cardiovascular risk factors, the STOP-BANG score (a questionnaire to screen for obstructive sleep apnea), and sleep study history and whether they were treated. For cardio-oncology patients only, the team collected baseline ultrasound results of LVEF and GLS.
The researchers compared the prevalence of traditional risk factors with the prevalence of sleep apnea in both the cardiology and cardio-oncology groups. Additionally, they compared baseline LVEF and GLS results in patients diagnosed with sleep apnea and low or high STOP-BANG scores in cardio-oncology patients.
General cardiology patients had a sleep apnea prevalence of 54% and cardio-oncology patients had a sleep prevalence of 35%. Cardio-oncology patients had higher sleep apnea than several traditional risk factors, such as diabetes (~29%), smoking (~46%), obesity (~52%), heart failure (~19%), kidney failure (~ 29%). %), stroke (~18%), heart attack (~11%), and grief (~33%).
The cardio-oncology group also had similar LVEF in patients with treated or untreated sleep apnea (5% vs 10% for EF ≤ 50; 95% vs 90% for EF ≥ 51) or with high STOP-BANG scores (14% for EF ≤ 50; 86% for EF ≥ 51). In contrast, GLS was significantly abnormal in patients with untreated sleep apnea (35% for GLS ≥ – 17.9) and patients with high STOP-BANG scores (31% for GLS ≥ – 17.9; 69%). for GLS ≤ – 18. Abnormal GLS is a common parameter associated with adverse cardiovascular events.
The prevalence of sleep apnea in the general cardiology group was similar to that in patients with HFrEF (52%) or heart failure with preserved ejection fraction (48%).
“We believe that sleep apnea should be added to current risk algorithms and a larger study is needed to evaluate the impact of sleep apnea and treatment outcomes in this high-risk population,” the researchers concluded. “Until then, we believe screening for sleep apnea should be part of routine risk assessment for patients receiving cancer therapies.”
References
- Data show a significant prevalence of sleep apnea among cardio-oncology patients. EurekAlert! February 9, 2024. https://www.eurekalert.org/news-releases/1033660. Accessed February 12, 2024.
- Butera, A. Sleep apnea, atrial fibrillation identified in patients with heart failure. HCPLive. May 9, 2022. Accessed February 12, 2024.