OSA and Prognosis After Acute Cardiogenic Pulmonary Edema: The OSA-CARE Study

Background Acute cardiogenic pulmonary edema (ACPE) is a life-threatening condition. OSA may be a modifiable risk factor for ACPE recurrence. This study was designed to evaluate the impact of OSA on the incidence of cardiovascular events following ACPE recovery. Methods Consecutive patients with confirmed ACPE from 3 centers underwent a sleep study following clinical stabilization. OSA was defined as an apnea-hypopnea index (AHI) ≥ 15 events/h. The mean follow-up was 1 year, and the primary outcome was ACPE recurrence. Results A total of 104 patients were included in the final analysis; 61% of the patients had OSA. A higher rate of ACPE recurrence (25 vs 6 episodes; P  = .01) and a higher incidence of myocardial infarction (15 vs 0 episodes; P  = .0004) were observed in patients with OSA than in those without OSA. All 17 deaths occurred in the OSA group ( P  = .0001). In a Cox proportional hazards regression analysis, OSA was independently associated with ACPE recurrence (hazard ratio [HR], 3.3 [95% CI, 1.2-8.8]; P  = .01), incidence of myocardial infarction (HR, 2.3 [95% CI, 1.1-9.5]; P  = .02), cardiovascular death (HR, 5.4 [95% CI, 1.4-48.4]; P  = .004), and total death (HR, 6.5 [95% CI, 1.2-64.0]; P  = .005). When the analysis was limited only to patients with OSA, levels of AHI and hypoxemic burden and rates of sleep-onset ACPE were significantly higher in those who presented with ACPE recurrence or who died than in those who did not experience these events. Conclusions OSA is independently associated with higher rates of ACPE recurrence and both fatal and nonfatal cardiovascular events.