0437 Obstructive Sleep Apnea Symptom Subtypes and Hypoxic Burden Independently Predict Distinct Cardiovascular Outcomes
Bibliographic record
Abstract
Abstract Introduction Studies on heterogeneity of obstructive sleep apnea (OSA) have identified clinically relevant symptom-based subtypes and novel OSA-specific nocturnal hypoxemia measures. Evidence suggests that moderate-severe OSA patients with the excessively sleepy subtype have increased risk of incident major adverse cardiovascular events (MACE; composite of coronary heart disease, heart failure, stroke, or cardiovascular mortality) and that OSA-specific hypoxic burden (HB) is associated with increased risk of cardiovascular disease (CVD) mortality. However, no study has comprehensively examined their combined impact. This study provides a systematic assessment of the individual and combined contribution of these factors on incident CVD risk, addressing an important gap in evidence. Methods Participants from the Sleep Heart Health Study with high-quality oxygen saturation, OSA severity quantified by apnea-hypopnea index (AHI), and symptom data were included. Latent class analysis on 14 symptoms was used to classify participants with moderate-severe OSA (AHI≥15) into subtypes. HB was calculated from respiratory event-related hypoxia and sleep time. Cox proportional hazards models were used to assess the relative contributions of OSA symptom subtypes and HB (natural log transformed) on risk for CVD mortality and MACE, adjusted for demographic and CVD risk factors. Analyses were performed in both CVD-free participants and all participants (adjusted for CVD at baseline). Results A total of 5,027 participants were analyzed, with median follow-up of 11.6 years (CVD mortality) and 11.3 years (MACE). HB was independently associated with CVD mortality in all participants (HR[95% CI] = 1.44 [1.06-1.97]; p=0.021) and CVD-free participants (1.62 [1.12-2.35]; p=0.010) controlling for symptom subtype. Conversely, symptom subtypes were independently associated with MACE incidence among CVD-free participants, controlling for HB, with the excessively sleepy participants having nearly two-fold higher risk (HR[95% CI] = 1.98 [1.26-3.10]; p=0.003) compared to those without OSA. Conclusion OSA symptom subtypes and HB are independently associated with distinct CVD-related endpoints. Higher HB was associated with cardiovascular mortality, controlling for symptom subtype. The excessively sleepy subtype was at higher risk of new MACE, controlling for HB. Thus, both factors are important for understanding OSA-related CVD risk. Support (if any) AHA (20CDA35310360), NIH (P01HL094307, U01HL53916, U01HL53931, U01HL53934, U01HL53937, U01HL53938, U01HL53940, U01HL53941, U01HL64360 R24 HL114473, 75N92019R002).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".