Gandhi, Zainab

Introduction: Obesity is a known risk factor and causes worse cardiovascular outcomes in obstructive sleep apnea. With the growing use of cannabis in the US, so we aimed to assess the impact of cannabis use disorder (CUD) on risk of atrial tachyarrhythmias (atrial fibrillation, AF; atrial fibrillation, AFL) and stroke in young patients with obesity-associated obstructive sleep apnea (OOSA). Methods: The National Inpatient Sample (2015Oct-2017) with relevant ICD-10 codes were used to identify admissions among young adults (18-44 years) with OOSA. We then matched (1:1) two cohorts of cannabis use disorder (CUD+) vs. without (CUD-) with controlling potential sociodemographic confounders. Primary outcomes of interest were frequency and risk of atrial tachyarrhythmias and stroke assessed by multivariable analysis. Results: Of 7470 demographically-matched OOSA admissions, CUD+ and CUD- cohorts had 3735 hospitalizations in each cohort. Both cohorts were comparable mean age of 38 years and CUD+ cohort more frequently included male (66.6% vs. 53.5%), African American (40.0% vs. 30.1%) patients admitted non-electively (92.3% vs. 84.5%). Rates of drug abuse, hypertension, smoking and chronic pulmonary disease were higher but diabetes mellitus, hyperlipidemia, and renal failure were lower in CUD+ cohort vs. CUD- cohort (p<0.001). The frequency of AF/AFL (5.7% vs 7.4%) related admissions were lower; however, the risk of AF/AFL (OR:1.64, 95%CI:1.17-2.30, p=0.004) and stroke (OR:4.41, 95%CI:1.41-13.77, p<0.011) admissions were significantly higher in the OOSA-CUD+ cohort vs. CUD- cohort in the multivariable analysis controlled for relevant cardiovascular/extracardiac comorbidities and concomitant alcohol/drug abuse and smoking. Conclusions: This propensity-matched analysis highlights that recreational cannabis use in young patients with OOSA may alarmingly increase emergency hospitalizations and independently increase the risk of AF/AFL and stroke.

Background: Obstructive sleep apnea (OSA) increases the risk of stroke and cardiovascular diseases. However, its impact on geriatric patients with a prior history of stroke/transient ischemic attack (TIA) has not been adequately studied. Methods: We utilized the 2019 National Inpatient Sample in the US to identify geriatric patients with OSA (G-OSA) who had a prior history of stroke/TIA. We then compared subsequent stroke (SS) rates among sex and race subgroups. We also compared the demographics and comorbidities of SS+ and SS− groups and utilized logistic regression models to assess outcomes. Results: Out of 133,545 G-OSA patients admitted with a prior history of stroke/TIA, 4.9% (6520) had SS. Males had a higher prevalence of SS, while Asian-Pacific Islanders and Native Americans had the highest prevalence of SS, followed by Whites, Blacks, and Hispanics. The SS+ group had higher all-cause in-hospital mortality rates, with Hispanics showing the highest rate compared to Whites and Blacks (10.6% vs. 4.9% vs. 4.4%, p < 0.001), respectively. Adjusted analysis for covariates showed that complicated and uncomplicated hypertension (aOR 2.17 [95% CI 1.78–2.64]; 3.18 [95% CI 2.58–3.92]), diabetes with chronic complications (aOR 1.28 [95% CI 1.08–1.51]), hyperlipidemia (aOR 1.24 [95% CI 1.08–1.43]), and thyroid disorders (aOR 1.69 [95% CI 1.14–2.49]) were independent predictors of SS. The SS+ group had fewer routine discharges and higher healthcare costs. Conclusions: Our study shows that about 5% of G-OSA patients with a prior history of stroke/TIA are at risk of hospitalization due to SS, which is associated with higher mortality and healthcare utilization. Complicated and uncomplicated hypertension, diabetes with chronic complications, hyperlipidemia, thyroid disorders, and admission to rural hospitals predict subsequent stroke.