The Effect of Sleep Apnea on Cardiovascular Events in Different Acute Coronary Syndrome Phenotypes

Andrea Zapater, Manuel Sánchez-De-La-Torre, Ivan David Benítez, Adriano Targa, Sandra Bertran, Gerard Torres, Albina Aldomà, Jordi de Batlle, Jorge Abad, Joaquín Duran-Cantolla, Valentin Cabriada-Nuño, Olga Mediano, María José Masdeu, Carmen Muñoz, Juan Fernando Masa, Mónica de la Peña, Mercè Mayos, Ramon Coloma, Josep María Montserrat, Eusebi ChinerOlga Mínguez, Lydia Pascual, Anunciación Cortijo, Dolores Martínez, Mireia Dalmases, R. Doug McEvoy, Ferran Barbé, Alicia Sánchez-De-La-Torre, on behalf of the Spanish Sleep Network

Research output: Contribution to journalArticlepeer-review

54 Citations (Scopus)

Abstract

Rationale: Obstructive sleep apnea (OSA) is associated with increased cardiovascular disease (CVD) risk. Conversely, OSA has not been shown to increase recurrent cardiovascular events in patients with acute coronary syndrome (ACS). This lack of homogeneity could suggest that the deleterious effect of OSA and its contribution to CVD could depend on specific patient profiles. 

Objectives: To evaluate the effect of OSA on cardiovascular risk for patients with different ACS phenotypes. 

Methods: Post hoc analysis of the ISAACC (Continuous Positive Airway Pressure in Patients with ACS and OSA) study, including 1,701 patients admitted for ACS (NCT 01335087). To evaluate the presence of OSA (apnea–hypopnea index > 15 events $ h21), all patients underwent polygraphy. Patients were followed up for a minimum period of 1 year. We performed nonsupervised clustering using latent class analysis to identify subgroups of patients on the basis of 12 clinical factors associated with cardiovascular risk. The effect of OSA on recurrent cardiovascular event risk was evaluated for each phenotype identified. 

Measurements and Main Results: Two phenotypes were identified: patients without previous heart disease and without previous ACS (“no-previous-CVD” phenotype; 81%) and patients with previous heart disease and previous ACS (“previous-CVD” phenotype; 19%). The median (interquartile range) at follow-up was 2.67 (3.8) years. For the no-previous-CVD phenotype, the effect of OSA showed an adjusted hazard ratio (95% confidence interval) of 1.54 (1.06–2.24; P value = 0.02), whereas for the previous-CVD phenotype, the effect of OSA showed an adjusted hazard ratio of 0.69 (0.46–1.04; P value = 0.08). 

Conclusions: For patients with ACS and a specific phenotype, OSA is associated with an increased risk of recurrent cardiovascular events. These patients are mainly characterized by no previous heart disease and admission for a first ACS occurrence.

Original languageEnglish
Pages (from-to)1698-1706
Number of pages9
JournalAmerican journal of respiratory and critical care medicine
Volume202
Issue number12
DOIs
Publication statusPublished - 15 Dec 2020

Keywords

  • ACS
  • Cardiovascular disease
  • Clinical phenotypes
  • Obstructive sleep apnea
  • Precision medicine

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