title: Risks associated with use of stimulant medications in patients with obstructive sleep apnea and cardiomyopathy: a case-control study.
abstract: OBJECTIVE
  Stimulant medications are indicated in patients with obstructive sleep apnea (OSA) who experience sleepiness despite optimal control of sleep-disordered breathing. The safety of stimulant medications in patients with OSA and co-morbid cardiomyopathy is unknown. We performed a case-control study to assess cardiovascular outcomes and mortality risk associated with stimulant use in this group of patients.
  
  
  METHODS
  A total of 162 subjects with OSA and cardiomyopathy were identified. Subjects who used stimulant medications for ≥1 month were designated as cases. Age-and-sex-matched controls not taking these medications were randomly chosen from the same cohort. Outcomes assessed were mortality, implantable cardioverter-defibrillator (ICD) and pacemaker insertion.
  
  
  RESULTS
  Twenty-two cases and 44 controls were included in the analyses. Mean age was 62.6 ± 15 years, 72% were male. Median duration of medication use was 27 months (range 1-98). There were four deaths among cases versus eight among controls. Four cases had a pacemaker and six had an ICD inserted, compared to six and eight respectively in the control group. Age (p = 0.01) and positive airway pressure (PAP) compliance (p = 0.01), but not stimulant medication use (p = 1.00) were associated with mortality on univariate analysis. In multiple logistic regression analyses accounting for body mass index, apnea-hypopnea index/respiratory disturbance index, PAP compliance, ejection fraction and duration of follow up, use of stimulant medication was not associated with mortality (p = 0.50), pacemaker (p = 0.20) or ICD (p = 0.90) implantation.
  
  
  CONCLUSIONS
  Stimulant medications were not associated with elevated risk of mortality, pacemaker or ICD implantation in this case-control study, even after accounting for multiple confounders.
authors.affiliation: Center for Sleep Medicine, Mayo Clinic, 200 2nd Street SW, Rochester, MN, 55905, USA. Electronic address: mansukhani.meghna@mayo.edu.
authors.forename: Meghna P
authors.initials: MP
authors.lastname: Mansukhani
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, 200 2nd Street SW, Rochester, MN, 55905, USA. Electronic address: kolla.bhanuprakash@mayo.edu.
authors.forename: Bhanu Prakash
authors.initials: BP
authors.lastname: Kolla
authors.affiliation: Center for Sleep Medicine, Mayo Clinic, 200 2nd Street SW, Rochester, MN, 55905, USA; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 2nd Street SW, Rochester, MN, 55905, USA. Electronic address: park.john@mayo.edu.
authors.forename: John G
authors.initials: JG
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000150:complications*; D016022:Case-Control Studies; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D015331:Cohort Studies; D006970:Disorders of Excessive Somnolence / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications*
chemical_list: D000697:Central Nervous System Stimulants
keywords: Central nervous system stimulant; Heart failure; Hypersomnia; Sleep disordered breathing; Somnolence; Wakefulness promoting agent