Association of Obstructive Sleep Apnea With Cardiovascular Outcomes in Patients With Acute Coronary Syndrome

<jats:sec xml:lang="en"> <jats:title>Background</jats:title> <jats:p xml:lang="en"> The prognostic significance of obstructive sleep apnea ( <jats:styled-content style="fixed-case">OSA</jats:styled-content> ) in patients with acute coronary syndrome ( <jats:styled-content style="fixed-case">ACS</jats:styled-content> ) in the contemporary era is unclear. We performed a large, prospective cohort study and did a landmark analysis to delineate the association of <jats:styled-content style="fixed-case">OSA</jats:styled-content> with subsequent cardiovascular events after <jats:styled-content style="fixed-case">ACS</jats:styled-content> onset. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Methods and Results</jats:title> <jats:p xml:lang="en"> Between June 2015 and May 2017, consecutive eligible patients admitted for <jats:styled-content style="fixed-case">ACS</jats:styled-content> underwent cardiorespiratory polygraphy during hospitalization. <jats:styled-content style="fixed-case">OSA</jats:styled-content> was defined as an apnea‐hypopnea index ≥15 events·h <jats:sup>−1</jats:sup> . The primary end point was major adverse cardiovascular and cerebrovascular event ( <jats:styled-content style="fixed-case">MACCE</jats:styled-content> ), including cardiovascular death, myocardial infarction, stroke, ischemia‐driven revascularization, or hospitalization for unstable angina or heart failure. <jats:styled-content style="fixed-case">OSA</jats:styled-content> was present in 403 of 804 (50.1%) patients. During median follow‐up of 1 year, cumulative incidence of <jats:styled-content style="fixed-case">MACCE</jats:styled-content> was significantly higher in the <jats:styled-content style="fixed-case">OSA</jats:styled-content> group than in the non‐ <jats:styled-content style="fixed-case">OSA</jats:styled-content> group (log‐rank, <jats:italic>P</jats:italic> =0.041). Multivariate analysis showed that <jats:styled-content style="fixed-case">OSA</jats:styled-content> was nominally associated with incidence of <jats:styled-content style="fixed-case">MACCE</jats:styled-content> (adjusted hazard ratio, 1.55; 95% CI, 0.94–2.57; <jats:italic>P</jats:italic> =0.085). In the landmark analysis, patients with <jats:styled-content style="fixed-case">OSA</jats:styled-content> had 3.9 times the risk of incurring a <jats:styled-content style="fixed-case">MACCE</jats:styled-content> after 1 year (adjusted hazard ratio, 3.87; 95% CI, 1.20–12.46; <jats:italic>P</jats:italic> =0.023), but no increased risk was found within 1‐year follow‐up (adjusted hazard ratio, 1.18; 95% CI, 0.67–2.09; <jats:italic>P</jats:italic> =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 <jats:styled-content style="fixed-case">OSA</jats:styled-content> group than in the non‐ <jats:styled-content style="fixed-case">OSA</jats:styled-content> group (adjusted hazard ratio, 2.10; 95% CI, 1.09–4.05; <jats:italic>P</jats:italic> =0.027). </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Conclusions</jats:title> <jats:p xml:lang="en"> There was no independent correlation between <jats:styled-content style="fixed-case">OSA</jats:styled-content> and 1‐year <jats:styled-content style="fixed-case">MACCE</jats:styled-content> after <jats:styled-content style="fixed-case">ACS</jats:styled-content> . The increased risk associated with <jats:styled-content style="fixed-case">OSA</jats:styled-content> was only observed after 1‐year follow‐up. Efficacy of <jats:styled-content style="fixed-case">OSA</jats:styled-content> treatment as secondary prevention after <jats:styled-content style="fixed-case">ACS</jats:styled-content> requires further investigation. </jats:p> </jats:sec>