Abstract 4145118: The Association Between Obstructive Sleep Apnea and Major Adverse Limb Events in Patients with Peripheral Arterial Disease

Background: Obstructive Sleep Apnea (OSA) is the most common sleep related disorder and shares common pathophysiological mechanisms with Peripheral Arterial Disease (PAD). Studies exploring the influence of OSA on PAD have largely focused on subclinical markers of PAD such as ankle brachial indices and pulse wave velocities. We sought to investigate the association of OSA with Major Adverse Limb Events (MALE) in patients with PAD. Methods: National Inpatient Sample 2018-2020 was utilized for this analysis. MALE was the primary outcome, defined as a composite of Acute Limb Ischemia, Limb Revascularization (either percutaneous or surgical), limb amputation and All-Cause mortality. ICD-10 codes were utilized to identify the diagnoses of choice. Propensity score matching was performed between the 2 groups of OSA and no OSA using the caliper match method for the variables, Age, Gender, Stroke, Obesity, Hypertension, Anemia, Coagulopathy, ESRD, Diabetes, Chronic Pulmonary Disease, Congestive Heart Failure, Cardiac Arrythmias and Valvular Heart Disease. Weighted samples were utilized and p<0.05 was considered statistically significant. Results: Our sample consisted of 1,947,125 patients with PAD with a mean age of 74 (57-91) and 56% were male. Patients with OSA had higher incidence of hypertension, diabetes, congestive heart failure, obesity and pulmonary circulation disorders compared to those without OSA and similar rates of ESRD, valvular heart disease and cardiac arrythmias (Table). On unadjusted analysis, patients with OSA had lower odds of composite outcome of MALE (OR: 0.65 p<0.05) which persisted after propensity matching (OR: 0.68 p<0.05) (Table). The incidence of myocardial infarction was the same between the two groups. Conclusion: Patients with OSA had lower rates of MALE compared to patients without OSA in PAD cases. It remains unclear if this paradoxical effect is due to biological factors such as intermittent nocturnal hypoxia promoting angiogenesis or is the result of unmeasured confounders such as OSA severity, positive airway pressure therapy and healthier lifestyle habits. Nonetheless, our findings highlight the need for well-designed prospective studies to further investigate this relationship.