TY - JOUR
T1 - Association of obstructive sleep apnea with C ardiovascular outcomes in patients with acute coronary syndrome
AU - Fan, Jingyao
AU - Wang, Xiao
AU - Ma, Xinliang
AU - Somers, Virend K.
AU - Nie, Shaoping
AU - Wei, Yongxiang
N1 - Funding Information:
This study was supported by grants from the International Science & Technology Cooperation Program of China (2015DFA30160), National Natural Science Foundation of China (81600209, 81870322), Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (ZYLX201710), Beijing Municipal Administration of Hospitals’ Ascent Plan (DFL20180601), Beijing Municipal Science and Technology Commission (Z181100001718060), Beijing Municipal Administration of Hospitals’ Youth Program (QML20160605), and Beijing Municipal Administration of Hospitals Incubating Program (PX2016048).
Publisher Copyright:
© 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Background The prognostic significance of obstructive sleep apnea (OSA) in patients with acute coronary syndrome (ACS) in the contemporary era is unclear. We performed a large, prospective cohort study and did a landmark analysis to delineate the association of OSA with subsequent cardiovascular events after ACS onset. Methods and Results Between June 2015 and May 2017, consecutive eligible patients admitted for ACS underwent cardiorespiratory polygraphy during hospitalization. OSA was defined as an apnea-hypopnea index ≥15 events·h −1 . The primary end point was major adverse cardiovascular and cerebrovascular event (MACCE), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure. OSA was present in 403 of 804 (50.1%) patients. During median follow-up of 1 year, cumulative incidence of MACCE was significantly higher in the OSA group than in the non-OSA group (log-rank, P=0.041). Multivariate analysis showed that OSA was nominally associated with incidence of MACCE(adjusted hazard ratio, 1.55; 95% CI, 0.94–2.57; P=0.085). In the landmark analysis, patients with OSA had 3.9 times the risk of incurring a MACCE after 1 year (adjusted hazard ratio, 3.87; 95% CI, 1.20–12.46; P=0.023), but no increased risk was found within 1-year follow-up (adjusted hazard ratio, 1.18; 95% CI, 0.67–2.09; P=0.575). No significant differences were found in the incidence of cardiovascular death, myocardial infarction, and ischemia-driven revascularization, except for a higher rate of hospitalization for unstable angina in the OSA group than in the non-OSA group (adjusted hazard ratio, 2.10; 95% CI, 1.09–4.05; P=0.027). Conclusions There was no independent correlation between OSA and 1-year MACCE after ACS. The increased risk associated with OSA was only observed after 1-year follow-up. Efficacy of OSA treatment as secondary prevention after ACS requires further investigation.
AB - Background The prognostic significance of obstructive sleep apnea (OSA) in patients with acute coronary syndrome (ACS) in the contemporary era is unclear. We performed a large, prospective cohort study and did a landmark analysis to delineate the association of OSA with subsequent cardiovascular events after ACS onset. Methods and Results Between June 2015 and May 2017, consecutive eligible patients admitted for ACS underwent cardiorespiratory polygraphy during hospitalization. OSA was defined as an apnea-hypopnea index ≥15 events·h −1 . The primary end point was major adverse cardiovascular and cerebrovascular event (MACCE), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure. OSA was present in 403 of 804 (50.1%) patients. During median follow-up of 1 year, cumulative incidence of MACCE was significantly higher in the OSA group than in the non-OSA group (log-rank, P=0.041). Multivariate analysis showed that OSA was nominally associated with incidence of MACCE(adjusted hazard ratio, 1.55; 95% CI, 0.94–2.57; P=0.085). In the landmark analysis, patients with OSA had 3.9 times the risk of incurring a MACCE after 1 year (adjusted hazard ratio, 3.87; 95% CI, 1.20–12.46; P=0.023), but no increased risk was found within 1-year follow-up (adjusted hazard ratio, 1.18; 95% CI, 0.67–2.09; P=0.575). No significant differences were found in the incidence of cardiovascular death, myocardial infarction, and ischemia-driven revascularization, except for a higher rate of hospitalization for unstable angina in the OSA group than in the non-OSA group (adjusted hazard ratio, 2.10; 95% CI, 1.09–4.05; P=0.027). Conclusions There was no independent correlation between OSA and 1-year MACCE after ACS. The increased risk associated with OSA was only observed after 1-year follow-up. Efficacy of OSA treatment as secondary prevention after ACS requires further investigation.
KW - Acute coronary syndrome
KW - Obstructive sleep apnea
KW - Outcome
UR - http://www.scopus.com/inward/record.url?scp=85059908023&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85059908023&partnerID=8YFLogxK
U2 - 10.1161/JAHA.118.010826
DO - 10.1161/JAHA.118.010826
M3 - Article
C2 - 30636505
AN - SCOPUS:85059908023
SN - 2047-9980
VL - 8
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 2
M1 - e010826
ER -