Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
Eur J Med Res. 2023 Mar 1;28(1):107. doi: 10.1186/s40001-023-01071-0.
Whether obstructive sleep apnea (OSA) is associated with worse prognosis in patients with acute coronary syndrome (ACS) with or without prior stroke remains unclear. We investigated the association of OSA with cardiovascular events in ACS patients with or without prior stroke.
Between June 2015 and January 2020, we prospectively recruited eligible ACS patients who underwent cardiorespiratory polygraphy during hospitalization. We defined OSA as an apnea hypopnea index (AHI) ≥ 15 events/hour. The primary composite end point was major adverse cardiovascular and cerebrovascular events (MACCEs), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure.
Among 1927 patients enrolled, 207 patients had prior stroke (10.7%) and 1014 had OSA (52.6%). After a mean follow-up of 2.9 years, patients with stroke had significantly higher risk of MACCEs than those without stroke (hazard ratio [HR]:1.49; 95% confidence interval [CI]: 1.12-1.98, P = 0.007). The multivariate analysis showed that patients with OSA had 2.0 times the risk of MACCEs in prior stroke group (41 events [33.9%] vs 18 events [20.9%]; HR:2.04, 95% CI:1.13-3.69, P = 0.018), but not in non-prior stroke group (186 events [20.8%] vs 144 events [17.4]; HR:1.21, 95% CI 0.96-1.52, P = 0.10). No significant interaction was noted between prior stroke and OSA for MACCE (interaction P = 0.17).
Among ACS patients, the presence of OSA was associated with an increased risk of cardiovascular events in patients with prior stroke. Further trials exploring the efficacy of OSA treatment in high-risk patients with ACS and prior stroke are warranted. Trial registration Clinicaltrials.gov identifier NCT03362385.
阻塞性睡眠呼吸暂停（OSA）是否与急性冠状动脉综合征（ACS）患者的预后不良相关，无论其是否合并既往卒中，目前尚不清楚。我们研究了 OSA 与 ACS 合并或不合并既往卒中患者心血管事件的相关性。
在 2015 年 6 月至 2020 年 1 月期间，我们前瞻性招募了住院期间接受心肺多导图检查的合格 ACS 患者。我们将 OSA 定义为呼吸暂停低通气指数（AHI）≥15 次/小时。主要复合终点为主要不良心脑血管事件（MACCE），包括心血管死亡、心肌梗死、卒、缺血驱动的血运重建或不稳定型心绞痛或心力衰竭住院。
在纳入的 1927 例患者中，207 例有既往卒中（10.7%），1014 例有 OSA（52.6%）。平均随访 2.9 年后，有卒中史的患者 MACCE 风险显著高于无卒中史的患者（风险比 [HR]：1.49；95%置信区间 [CI]：1.12-1.98，P=0.007）。多变量分析显示，在既往卒中组中，OSA 患者的 MACCE 风险增加 2 倍（41 例 [33.9%] 与 18 例 [20.9%]；HR：2.04，95%CI：1.13-3.69，P=0.018），但在非既往卒中组中无显著差异（186 例 [20.8%] 与 144 例 [17.4%]；HR：1.21，95%CI：0.96-1.52，P=0.10）。MACCE 中未观察到既往卒中与 OSA 之间的显著交互作用（交互 P=0.17）。
在 ACS 患者中，存在 OSA 与既往卒中患者心血管事件风险增加相关。需要进一步的试验来探索 OSA 治疗在合并既往卒中和 ACS 的高危患者中的疗效。试验注册 Clinicaltrials.gov 标识符 NCT03362385。
