Risks associated with use of stimulant medications in patients with obstructive sleep apnea and cardiomyopathy: a case-control study

Objectives: 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. (C) 2017 Elsevier B.V. All rights reserved.