Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China.
Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China.
Nutr Metab Cardiovasc Dis. 2023 Dec;33(12):2372-2383. doi: 10.1016/j.numecd.2023.07.024. Epub 2023 Jul 26.
The association of comorbidities on the prognosis of patients with acute coronary syndrome (ACS) was well documented. However, the impact of obstructive sleep apnea (OSA) on this association has been less studied.
Between June 2015 to Jan 2020, we included consecutively eligible patients with ACS who underwent cardiorespiratory polygraphy. The definition of OSA was apnea-hypopnea index (AHI) ≥15 events/hour. Charlson Comorbidity Index (CCI) was used to evaluate the comorbidities. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, and hospitalization for unstable angina or heart failure. In the 1927 ACS patients, 1014 (52.6%) had OSA. The prevalence of the mild (CCI = 0), moderate (CCI = 1-2), and severe (CCI≥3) comorbidity were 23.6%, 65.9%, and 10.5%, respectively. During a median follow-up of 2.9 (1.5, 3.6) years, compared with patients without OSA, the presence of OSA increased the risk of MACCE in the moderate comorbidity group (22.6% vs. 17.5%; adjusted HR: 1.327; 95% CI: 1.019-1.728, p = 0.036) and severe comorbidity group (36.2% vs. 18.6%; adjusted HR: 2.194; 95% CI: 1.170-4.117, p = 0.014). There was no significant difference between OSA and non-OSA patients in the mild comorbidity group.
Among ACS patients, OSA was associated with an increased risk of subsequent events in the moderate and severe comorbidity groups but not in the mild comorbidity group. ACS patients with comorbidities should not be overlooked for OSA screening.
合并症与急性冠状动脉综合征（ACS）患者的预后相关，这一点已有充分的文献记载。然而，阻塞性睡眠呼吸暂停（OSA）对这种相关性的影响研究较少。
2015 年 6 月至 2020 年 1 月，我们连续纳入接受心肺多导睡眠图检查的 ACS 患者。OSA 的定义为呼吸暂停低通气指数（AHI）≥15 次/小时。Charlson 合并症指数（CCI）用于评估合并症。主要终点是主要不良心血管和脑血管事件（MACCE），包括心血管死亡、心肌梗死、卒中和缺血驱动的血运重建，以及不稳定型心绞痛或心力衰竭住院。在 1927 例 ACS 患者中，1014 例（52.6%）患有 OSA。轻度（CCI=0）、中度（CCI=1-2）和重度（CCI≥3）合并症的患病率分别为 23.6%、65.9%和 10.5%。在中位数为 2.9（1.5，3.6）年的随访期间，与无 OSA 的患者相比，中重度合并症患者存在 OSA 时 MACCE 的风险增加（22.6%比 17.5%；调整后的 HR：1.327；95%CI：1.019-1.728，p=0.036）和重度合并症组（36.2%比 18.6%；调整后的 HR：2.194；95%CI：1.170-4.117，p=0.014）。在轻度合并症组中，OSA 患者与非 OSA 患者之间无显著差异。
在 ACS 患者中，OSA 与中重度合并症患者的后续事件风险增加相关，但与轻度合并症患者无关。合并症的 ACS 患者不应忽视 OSA 筛查。
