TY - JOUR
T1 - The Effect of Sleep Apnea on Cardiovascular Events in Different Acute Coronary Syndrome Phenotypes
AU - Zapater, Andrea
AU - Sánchez-De-La-Torre, Manuel
AU - Benítez, Ivan David
AU - Targa, Adriano
AU - Bertran, Sandra
AU - Torres, Gerard
AU - Aldomà, Albina
AU - de Batlle, Jordi
AU - Abad, Jorge
AU - Duran-Cantolla, Joaquín
AU - Cabriada-Nuño, Valentin
AU - Mediano, Olga
AU - Masdeu, María José
AU - Muñoz, Carmen
AU - Masa, Juan Fernando
AU - de la Peña, Mónica
AU - Mayos, Mercè
AU - Coloma, Ramon
AU - Montserrat, Josep María
AU - Chiner, Eusebi
AU - Mínguez, Olga
AU - Pascual, Lydia
AU - Cortijo, Anunciación
AU - Martínez, Dolores
AU - Dalmases, Mireia
AU - Doug McEvoy, R.
AU - Barbé, Ferran
AU - Sánchez-De-La-Torre, Alicia
AU - on behalf of the Spanish Sleep Network
AU - Abad, Laura
AU - Muñoz, Aida
AU - Zamora, Elisabet
AU - Vicente, Ignacio
AU - Inglés, Sandra
AU - Egea, Carlos
AU - Marcos, Jaime
AU - Fernández, Almudena
AU - Amibilia, Chechu
AU - Urrutia, Amaia
AU - Castro, Sonia
AU - Serrano, Leyre
AU - Florés, Marina
AU - Galera, Estefanía
AU - Mas, Anna
AU - Martínez, Montserrat
AU - Arbonés, Maricel
AU - Ortega, Silvia
AU - Martín, Alicia
AU - Román-Sánchez, Jose Miguel
AU - Valiente-Diaz, Isabel Mª
AU - Viejo-Ayuso, Esther Mª
AU - Rodríguez-García, Concepción
AU - Vigil, Laura
AU - Ramírez, Enriqueta
AU - Piñar, María
AU - Martínez, Elisabet
AU - Ordax, Estrella
AU - Barriuso, Blanca
AU - Corral, Jaime
AU - de Terreros Caro, Francisco Javier Gómez
AU - Barceló, Antonia
AU - Giménez, Paloma
AU - Carrera, Miguel
AU - Fortuna, Ana Mª
AU - Peñacoba, Patricia
AU - Martínez García, Abel Jesús
AU - Castillo, Sergio García
AU - Navas, Lara
AU - Garmendia, Onintza
AU - Sancho, José
AU - Perelló, Salvador
AU - Rubinós, Gemma
PY - 2020/12/15
Y1 - 2020/12/15
N2 - 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.
AB - 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.
KW - ACS
KW - Cardiovascular disease
KW - Clinical phenotypes
KW - Obstructive sleep apnea
KW - Precision medicine
UR - http://www.scopus.com/inward/record.url?scp=85098603405&partnerID=8YFLogxK
U2 - 10.1164/rccm.202004-1127OC
DO - 10.1164/rccm.202004-1127OC
M3 - Article
C2 - 32648771
AN - SCOPUS:85098603405
SN - 1073-449X
VL - 202
SP - 1698
EP - 1706
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 12
ER -