Zhang Zekun, Li Siyi, Wang Ge, Zhou Yun, Yan Yan, Fan Jingyao, Ai Hui, Gong Wei, Nie Shaoping
Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China; Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, China. 1 Dahua Road, Dongdan, Dongcheng District, Beijing, 100730, China.
Sleep Med. 2025 Aug;132:106593. doi: 10.1016/j.sleep.2025.106593. Epub 2025 May 16.
Currently, beta-blockers are recommended for non-ST elevation acute coronary syndrome (NSTE-ACS). However, there is still a lack of studies evaluating the use of beta-blockers in patients with NSTE-ACS complicated by obstructive sleep apnea (OSA).
This is the sub-analysis of OSA-ACS project (NCT03362385), a prospective, observational study recruited ACS patients undergoing portable sleep monitoring between June 2015 and January 2020. Patients with NSTE-ACS were selected in this analysis. The primary endpoint was major adverse cardiovascular events (MACE), including cardiovascular death, myocardial infarction or ischemia-driven revascularization.
After exclusion, 1452 NSTE-ACS patients were enrolled, and 75.3 % of patients received beta-blockers at discharge. The proportion of beta-blockers users in the OSA group was 77.4 % and 73.2 % in the non-OSA group, with no significant difference (P = 0.068). In OSA group, beta-blocker users had higher rate of MACE (18.2 % versus 9.0 %, adjusted hazard ratio [HR] 1.90, 95 % confidence interval [CI] 1.04-3.45, p = 0.037) but not in non-OSA group (14.1 % versus 9.9 %, adjusted HR 1.45, 95 % CI 0.80-2.62, p = 0.219). After propensity score matching, beta-blocker users were still at higher risk of MACE (19.3 % versus 9.3 %, adjusted HR 2.18, 95 % CI 1.09-4.35, p = 0.028) in OSA group, in contrast the risk was comparable in non-OSA group (13.2 % versus 9.9 %, adjusted HR 1.27, 95 % CI 0.63-2.57, p = 0.501). Sensitivity analysis was consistent with the main results. Subgroup analysis showed no significant interactions (P > 0.10, for all comparisons).
The administration of beta-blockers is associated with higher risk of adverse cardiovascular outcomes in NSTE-ACS patients with concomitant OSA.
目前，β受体阻滞剂被推荐用于非ST段抬高型急性冠状动脉综合征（NSTE-ACS）。然而，仍缺乏评估β受体阻滞剂在合并阻塞性睡眠呼吸暂停（OSA）的NSTE-ACS患者中应用的研究。
这是OSA-ACS项目（NCT03362385）的亚分析，该项目是一项前瞻性观察性研究，纳入了2015年6月至2020年1月期间接受便携式睡眠监测的ACS患者。本分析选取了NSTE-ACS患者。主要终点是主要不良心血管事件（MACE），包括心血管死亡、心肌梗死或缺血驱动的血运重建。
排除后，纳入了1452例NSTE-ACS患者，75.3%的患者出院时接受了β受体阻滞剂治疗。OSA组中β受体阻滞剂使用者的比例为77.4%，非OSA组为73.2%，差异无统计学意义（P = 0.068）。在OSA组中，β受体阻滞剂使用者发生MACE的比例较高（18.2%对9.0%，调整后风险比[HR]1.90，95%置信区间[CI]1.04 - 3.45，p = 0.037），但在非OSA组中无差异（14.1%对9.9%，调整后HR 1.45，95% CI 0.80 - 2.62，p = 0.219）。倾向评分匹配后，OSA组中β受体阻滞剂使用者发生MACE的风险仍然较高（19.3%对9.3%，调整后HR 2.18，95% CI 1.09 - 4.35，p = 0.028），相比之下，非OSA组风险相当（13.2%对9.9%，调整后HR 1.27，95% CI 0.63 - 2.57，p = 0.501）。敏感性分析与主要结果一致。亚组分析显示无显著交互作用（所有比较P > 0.10）。
在合并OSA的NSTE-ACS患者中，使用β受体阻滞剂与不良心血管结局风险较高相关。
