Obesity Paradox or Hypoxia Preconditioning: How Obstructive Sleep Apnea Modifies the Obesity-Mi Relationship

Authors

Amir Sharafkhaneh
Ritwick Agrawal
Vijay Nambi
Ahmed BaHammam
Javad Razjouyan

Publication Date

10-1-2023

Journal

Sleep Medicine

DOI

10.1016/j.sleep.2023.07.035

PMID

37574613

PMCID

PMC10529841

PubMedCentral® Posted Date

10-1-2024

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Humans, Body Mass Index, Hypoxia, Myocardial Infarction, Obesity, Obesity Paradox, Retrospective Studies, Sleep Apnea Syndromes, Sleep Apnea, Obstructive, intermitted hypoxia, hypoxic preconditioning, obesity paradox, survival

Abstract

OBJECTIVES: The objective of this study was to evaluate the interaction between obesity and obstructive sleep apnea on acute MI in hospital mortality.

METHODS: This retrospective cohort study utilized Veterans Health Administration data from years 1999-2020. Participants were categorized according to their body mass index (BMI) to non-obese (BMI

RESULTS: Among 72,036 veterans with acute-MI hospitalization, individuals with obesity and obstructive sleep apnea (OB-SA) had the lowest in-hospital mortality rate (1.0%) compared to those without obesity and obstructive sleep apnea (nOB-nSA, 2.8%), with obesity but without obstructive sleep apnea (OB-nSA, 2.4%), and with obesity and obstructive sleep apnea (nOB-SA, 1.4%). The adjusted odds ratio for mortality, compared to nOB-nSA, was 9% higher but not significant in OB-nSA (aOR, 1.09, 95%CI: 0.95, 1.25), 46% lower in OB-nSA (aOR, 0.54, 95%CI: 0.45, 0.66), and 52% lower in OB-SA (aOR, 0.48: 95%CI: 0.41, 0.57).

CONCLUSION: Our data suggest that the association between obesity and improved survival in acute MI is largely driven by the presence of sleep apnea.

Comments

Associated Data