Abstract Body (Do not enter title and authors here): BACKGROUND Obstructive sleep apnea (OSA) is a prevalent comorbidity strongly associated with cardiovascular diseases, particularly in patients with aortic dissection (AD). However, the long-term impact of severe OSA on survival and distal aortic remodeling after total arch replacement for acute type A aortic dissection (ATAAD) remains unclear.
OBJECTIVES This study aimed to elucidate the specific long-term prognostic impact of severe OSA in patients undergoing ATAAD repair.
METHODS A total of 86 prospectively collected patients who underwent acute type A aortic dissection repair at Beijing Anzhen Hospital between January 2018 and December 2018 were enrolled in the study. All these patients underwent total aortic arch replacement. All patients underwent sleep monitoring within 90 days postoperatively. The association between severe OSA and major adverse events (MAEs) was analyzed using a multivariable Cox proportional hazards model. Kaplan-Meier survival analysis was performed to assess long-term survival.
RESULTS Of these 86 patients, 22 (25.6%) exhibiting severe OSA and 64 (74.4%) not. Individuals with severe OSA had a notably higher rate of major adverse events (MAEs) compared to those without severe OSA (27.3% vs. 7.8%, P=0.047) and a significantly lower long-term survival rate (81.8% vs. 97.4%, P=0.003). After adjusting for potential confounding variables, severe OSA remained an independent predictor of MAEs (HR=3.7, 95% CI: 1.1–12.4, P=0.032). Imaging follow-ups indicated that patients with severe OSA experienced significantly higher stent-graft distal aortic expansion rates (1.8 mm/year vs. 0.4 mm/year, P=0.030), abdominal aortic expansion rates (2.2 mm/year vs. 0.7 mm/year, P<0.001), and false lumen expansion rates in the descending aorta (2.5 mm/year vs. 0.8 mm/year, P=0.003). Moreover, partial thrombosis of the false lumen was more frequently observed in patients with severe OSA (40.9% vs. 14.1%, P=0.028). Conversely, complete false lumen thrombosis (64.1% vs. 45.5%, P=0.028) and false lumen patency (21.9% vs. 13.6%, P=0.028) were more commonly observed in patients without severe OSA.
CONCLUSIONS Severe OSA is associated with an elevated risk of MAEs and is implicated in abnormal distal aortic expansion and false lumen thrombosis among patients undergoing ATAAD repair. These results highlight the importance role of identifying and managing severe OSA in the long-term postoperative care of patients with ATAAD.