阻塞性睡眠呼吸暂停和甘油三酯葡萄糖指数对急性冠脉综合征患者心血管事件的影响：OSA-ACS研究的事后分析

Impact of Obstructive Sleep Apnea and Triglyceride Glucose Index on Cardiovascular Events in Acute Coronary Syndrome Patients: A Post-Hoc Analysis of the OSA-ACS Study.

作者信息

Zhang Yuekun, Xu Ding, Zheng Wen, Hao Wen, Zhen Lei, Yan Yan, Wang Xiao, Nie Shaoping

机构信息

Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China.

Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China.

出版信息

Rev Cardiovasc Med. 2025 May 21;26(5):36205. doi: 10.31083/RCM36205. eCollection 2025 May.

DOI:10.31083/RCM36205

PMID:40475723

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12135658/

Abstract

BACKGROUND

Obstructive sleep apnea (OSA) is highly prevalent in patients with acute coronary syndrome (ACS). The triglyceride glucose (TyG) index is considered closely linked to cardiovascular risk. However, the relationship between OSA, TyG index, and cardiovascular outcomes in ACS patients remains unclear. Hence, this study aimed to examine the effects of OSA and the TyG index on cardiovascular outcomes in ACS patients.

METHODS

This post-hoc analysis included 1853 patients from the OSA-ACS project, a single-center prospective cohort study that enrolled ACS patients admitted between January 2015 and December 2019. OSA was defined as an apnea-hypopnea index of ≥15 events/hour. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE). Multivariable Cox regression models were used to evaluate the impact of OSA on cardiovascular events across the TyG index categories.

RESULTS

OSA was present in 52.5% of the participants, with a mean TyG index of 9.02 ± 0.68. Over a median follow-up of 35.1 (19.0-43.5) months, OSA was significantly associated with a heightened risk of MACCE (adjusted hazard ratio (aHR): 1.556; 95% confidence interval (CI): 1.040-2.326; = 0.031) in the high TyG group within the fully adjusted model, along with elevated risk of hospitalization for unstable angina (aHR: 1.785; 95% CI: 1.072-2.971; = 0.026). No significant associations were observed between OSA and MACCE in the low and moderate TyG groups.

CONCLUSIONS

This analysis demonstrates that OSA significantly increases the risk of adverse cardiovascular events in ACS patients with a high TyG index, underscoring the importance of routine OSA screening in these high-risk ACS patients to optimize cardiovascular risk stratification and personalize treatment strategies.

THE CLINICAL TRIAL REGISTRATION

NCT03362385, https://clinicaltrials.gov/expert-search?term=NCT03362385.

摘要

背景

阻塞性睡眠呼吸暂停（OSA）在急性冠状动脉综合征（ACS）患者中高度流行。甘油三酯葡萄糖（TyG）指数被认为与心血管风险密切相关。然而，OSA、TyG指数与ACS患者心血管结局之间的关系仍不清楚。因此，本研究旨在探讨OSA和TyG指数对ACS患者心血管结局的影响。

方法

本事后分析纳入了OSA-ACS项目中的1853例患者，该项目是一项单中心前瞻性队列研究，纳入了2015年1月至2019年12月期间收治的ACS患者。OSA被定义为呼吸暂停低通气指数≥15次/小时。主要终点是主要不良心血管和脑血管事件（MACCE）。多变量Cox回归模型用于评估OSA对不同TyG指数类别中心血管事件的影响。

结果

52.5%的参与者存在OSA，平均TyG指数为9.02±0.68。在中位随访35.1（19.0-43.5）个月期间，在完全调整模型中，OSA与高TyG组中MACCE风险增加显著相关（调整后风险比（aHR）：1.556；95%置信区间（CI）：1.040-2.326；P = 0.031），同时不稳定型心绞痛住院风险也升高（aHR：1.785；95%CI：1.072-2.971；P = 0.026）。在低TyG组和中TyG组中，未观察到OSA与MACCE之间存在显著关联。