• Chest · Apr 2021

    Multicenter Study

    Prolonged Circulation Time is Associated with Mortality Among Older Men with Sleep Disordered Breathing.

    • Younghoon Kwon, Scott A Sands, Katie L Stone, Luigi Taranto-Montemurro, Raichel M Alex, David P White, Andrew Wellman, Susan Redline, and Ali Azarbarzin.
    • Department of Medicine, University of Washington, Seattle, WA. Electronic address: yhkwon@uw.edu.
    • Chest. 2021 Apr 1; 159 (4): 1610-1620.

    BackgroundConventional metrics to evaluate sleep-disordered breathing (SDB) have many limitations, including their inability to identify subclinical markers of cardiovascular (CV) dysfunction.Research QuestionDoes sleep study-derived circulation time (Ct) predict mortality, independent of CV risks and SDB severity?Study Design And MethodsWe derived average lung to finger Ct (LFCt) from sleep studies in older men enrolled in the multicenter Osteoporotic Fractures in Men (MrOS) Sleep study. LFCt was defined as the average time between end of scored respiratory events and nadir oxygen desaturations associated with those events. We calculated the hazard ratio (HRs) for the CV and all-cause mortality by LFCt quartiles, adjusting for the demographic characteristics, body habitus, baseline CV risk, and CV disease (CVD). Additional models included apnea-hypopnea index (AHI), time with oxygen saturation as measured by pulse oximetry (SpO2) < 90% (T90), and hypoxic burden. We also repeated analyses after excluding those with CVD at baseline.ResultsA total of 2,631 men (mean ± SD age, 76.4 ± 5.5 years) were included in this study. LFCt median (interquartile range) was 18 (15-22) s. During an average ± SD follow-up of 9.9 ± 3.5 years, 427 men (16%) and 1,205 men (46%) experienced CV death and all-cause death, respectively. In multivariate analysis, men in the fourth quartile of LFCt (22-52 s) had an HR of 1.36 (95% CI, 1.02-1.81) and 1.35 (95% CI, 1.14-1.60) for CV and all-cause mortality, respectively, when compared with men in the first quartile (4-15 s). The results were similar when additionally adjusting for AHI, T90, or hypoxic burden. Results were stronger among men with no history of CVD at baseline.InterpretationLFCt is associated with both CV and all-cause mortality in older men, independent of baseline CV burden and SDB metrics. LFCt may be a novel physiologic marker for subclinical CVD and adverse outcomes in patients with SDB.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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