Clinical Investigation
Impact of obstructive sleep apnea on the long-term cardiovascular outcomes in patients with acute coronary syndrome
Wang Xiao, Hao Wen, Fan Jingyao, Guo Ruifeng, Huang Xin, Li Zexuan, Li Siyi, Wang Ge, Zhang Ying, Gong Wei, Nie Shaoping
Published 2021-08-24
Cite as Chin J Cardiol, 2021, 49(8): 776-782. DOI: 10.3760/cma.j.cn112148-20210423-00368
Abstract
ObjectiveTo investigate the impact of obstructive sleep apnea (OSA) on long-term cardiovascular outcomes in patients with acute coronary syndrome (ACS).
MethodsThis is a single-center, prospective cohort study. Between June 2015 to January 2020, consecutive ACS patients hospitalized at Beijing Anzhen Hospital, Capital Medical University were enrolled. All patients underwent portable sleep breathing monitoring, and they were then divided into moderate/severe OSA group (apnea-hypopnea index (AHI)≥15 events/hour) and no/mild OSA group (AHI<15 events/hour). The primary endpoint was major adverse cardiac and cerebrovascular event (MACCE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, ischemia-driven revascularization and hospital admission for unstable angina or heart failure. MACCE were compared yearly by the log-rank test. Multivariable Cox regression analyses were performed to determine the independent predictors of MACCE.
ResultsA total of 1 927 patients with ACS were enrolled, including 1 629 males (84.5%), aged (56.4±10.5) years. Moderate/severe OSA was present in 1 014 (52.6%) patients. Compared with no/mild OSA group, moderate/severe OSA group exhibited a higher body mass index (P<0.05). Hypertension, prior PCI were more prevalent in moderate/severe OSA group (bothP<0.05). The difference of ACS category between the two groups was statistically significant (P=0.021). The rate of patients who underwent PCI and the number of stents were higher in the moderate/severe OSA group. During a 5-year follow-up (median 2.9 years (IQR 1.5-3.6 years)), the cumulative incidence of MACCE was significantly higher in the moderate/severe OSA group than in the no/mild OSA group (34.0% vs. 24.0%, HR=1.346, 95%CI 1.100-1.646, log-rank P=0.004). The cumulative incidence of MACCE remained statistically higher at 4 and 5 year in the moderate/severe OSA group as compared to the no/mild OSA group (33.3% vs. 22.9%, HR=1.397, 95%CI 1.141-1.710, log-rankP=0.001; 34.0% vs. 24.0%, HR=1.341, 95%CI 1.096-1.640, log-rankP=0.004, respectively). Multivariate analysis showed that moderate/severe OSA (HR=1.312, 95%CI 1.054-1.631, P=0.015) was an independent predictor of long-term MACCE in ACS patients.
ConclusionsModerate/severe OSA is observed in more than 52% ACS patients. Moderate/severe OSA is an independent predictor of long-term MACCE.
Key words:
Sleep apnea, obstructive; Acute coronary syndrome; Cardiovascular events
Contributor Information
Wang Xiao
Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Hao Wen
Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Fan Jingyao
Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Guo Ruifeng
Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Huang Xin
Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Li Zexuan
Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Li Siyi
Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Wang Ge
Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Zhang Ying
Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
Gong Wei
Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Nie Shaoping
Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
