Association between cardiovascular mortality and STOP-Bang questionnaire scores in a cohort of hospitalized patients: a prospective study

Valdivia, Gabriel; Schmidt, Alexia; Schmidt, Bettina; Rivera, Francisca; Oñate, Aileen; Navarrete, Camila; Campos, Josue; Labarca, Gonzalo

doi:10.36416/1806-3756/e20210039

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ORIGINAL ARTICLE • J. bras. pneumol. 47 (04) • 2021 • https://doi.org/10.36416/1806-3756/e20210039 copy

Association between cardiovascular mortality and STOP-Bang questionnaire scores in a cohort of hospitalized patients: a prospective study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

Obstructive sleep apnea (OSA) is associated with an increased risk of mortality and cardiometabolic diseases. The STOP-Bang questionnaire is a tool to screen populations at risk of OSA and prioritize complementary studies. Our objective was to evaluate the clinical utility of this questionnaire in identifying patients at an increased risk of mortality after discharge in a cohort of hospitalized patients.

Methods:

This was a prospective cohort study involving consecutive patients admitted to an internal medicine unit between May and June of 2017 who were reevaluated three years after discharge. At baseline, we collected data on comorbidities (hypertension, obesity, diabetes, and fasting lipid profile) and calculated STOP-Bang scores, defining the risk of OSA (0-2 score, no risk; ≥ 3 score, risk of OSA; and ≥ 5 score, risk of moderate-to-severe OSA), which determined the study groups. We also recorded data regarding all-cause and cardiovascular mortality at the end of the follow-up period.

Results:

The sample comprised 435 patients. Of those, 352 (80.9%) and 182 (41.8%) had STOP-Bang scores ≥ 3 and ≥ 5, respectively. When compared with the group with STOP-Bang scores of 0-2, the two groups showed higher prevalences of obesity, hypertension, diabetes, and dyslipidemia. Multivariate analysis showed an independent association between cardiovascular mortality and STOP-Bang score ≥ 5 (adjusted hazard ratio = 3.12 [95% CI, 1.39-7.03]; p = 0.01). Additionally, previous coronary heart disease was also associated with cardiovascular mortality.

Conclusions:

In this cohort of hospitalized patients, STOP-Bang scores ≥ 5 were able to identify patients at an increased risk of cardiovascular mortality three years after discharge.

Keywords:
Sleep Apnea, Obstructive; Risk assessment; Surveys and questionnaires; Cardiovascular diseases/mortality

Characteristic	STOP-Bang score			p*
	0-2	≥ 3	≥ 5
	(n = 83)	(n = 352)	(n = 182)
Age, years	56.61 ± 18.74	62.01 ± 16.57	62.55 ± 15.04	0.01
Age ≥ 65 years	38.5%	47.4%	65.1%	0.12
Male	44.57%	55.68%	60.43%	0.01
BMI, kg/m²	30.72 ± 5.73	33.93 ± 6.58	35.78 ± 6.96	< 0.01
BMI ≥ 35 kg/m²	9.4%	12.5%	14.1%	< 0.01
ASCVD, %	10.1 ± 11.2	22.6 ± 16.3	24.6 ± 15.8	< 0.01
Former/current smoking	38.4%	52.3%	59.1%	< 0.01
Hypertension	19.2%	73.2%	84.0%	< 0.01
Diabetes mellitus	14.4%	43.7%	50.0%	< 0.01
Dyslipidemia	37.3%	59.3%	59.3%	0.01
Hypertriglyceridemia	41.9%	33.9%	34.3%
High LDL	38.7%	28.7%	24.0%
Mixed dyslipidemia	19.3%	37.3%	41.6%
Medication
Lipid-lowering	31.6%	48.3%	43.5%	< 0.01
Antidiabetic	9.2%	39.4%	48.1%	< 0.01
Anticoagulant	16.2%	52.0%	71.5%	< 0.01
Antihypertensive	15.2%	68.7%	75.4%	< 0.01
Reason for admission
Decompensated HF	12.0%	13.0%	10.9%	0.47
AF	4.6%	34.0%	1.0%	0.17
CHD	15.6%	15.9%	13.7%	0.40
AMI	1.2%	2.5%	37.9%	0.29

	Unadjusted HR (95% CI)	p	Adjusted HR* (95% CI)	p
All-cause mortality
STOP-Bang ≥ 3	1.36 (0.77-2.36)	0.28	1.52 (0.83-2.79)	0.17
STOP-Bang ≥ 5	1.45 (0.96-2.20)	0.07	1.58 (1.01-2.48)	0.04
Cardiovascular mortality
STOP-Bang ≥ 3	2.94 (0.88-9.78)	0.07	4.67 (1.27-17.08)	0.02
STOP-Bang ≥ 5	2.31 (1.13-4.70)	0.04	3.12 (1.39-7.03)	0.01

Baseline characteristic	Group		p
	All-cause mortality	Survival
	(n = 95)	(n = 340)
Age, years	68.1 ± 14.3	59.3 ± 17.3	< 0.01
Age ≥ 65 years	61.7	42.0	0.01
Male	61.7	51.6	0.06
STOP-Bang score	4.2 ± 1.4	3.9 ± 1.8	0.19
≥ 3	87.6	79.3	0.05
≥ 5	48.1	40.3	0.12
Hypertension	77.7	59.6	0.01
Diabetes mellitus	44.4	36.7	0.12
Dyslipidemia	54.3	55.3	0.48
BMI ≥ 35 kg/m²	9.8	10.7	0.50
Reason for admission
Decompensated HF	13.5	12.7	0.47
Unstable angina	49.3	18.3	0.01
AMI	1.2	25.4	0.41
AF	3.7	33.8	0.55

Baseline characteristic	Group		p
	CV mortality	Survival
	(n = 34)	(n = 340)
Age, years	73.8 ± 11.8	60.4 ± 17.1	0.02
Age ≥ 65 years	75.0	43.7	0.01
Male	67.8	52.5	0.08
STOP-Bang score	4.6 ± 1.1	3.9 ± 1.7	0.04
≥ 3	86.4	79.8	0.06
≥ 5	67.1	40.7	0.01
Hypertension	67.8	62.6	0.36
Diabetes mellitus	50.0	37.3	0.12
Dyslipidemia	46.4	55.7	0.08
BMI ≥ 35 kg/m²	13.5	11.0	0.48
Reason for admission
Decompensated HF	25.0	12.0	0.05
Unstable angina	10.7	16.2	0.32
AMI	3.5	2.2	0.49
AF	10.7	2.9	0.06

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E-mail: jbp@sbpt.org.br

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[1] Correspondence to: Gonzalo Labarca. Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, 221 Longwood Avenue, ZIP code 02115, Boston (MA) USA. Tel.: 1 617 955-2145. E-mail: glabarca@bwh.harvard.edu