Qiu Yuyao, Li Zexuan, Hao Wen, Liu Xiaochen, Guo Qian, Guo Yingying, Que Bin, Gong Wei, Zheng Wen, Wang Xiao, Nie Shaoping
Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China.
Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730 Beijing, China.
Rev Cardiovasc Med. 2025 Jul 28;26(7):33439. doi: 10.31083/RCM33439. eCollection 2025 Jul.
Excessive daytime sleepiness (EDS) is a commonly observed symptom in people with obstructive sleep apnea (OSA). However, the impact of EDS on the outcome of patients with acute coronary syndrome (ACS) and OSA is not known. Therefore, this study aimed to investigate the association between OSA and cardiovascular events in ACS patients with or without EDS.
This cohort study prospectively enrolled eligible ACS patients who underwent cardiorespiratory polygraphy during hospitalization between June 2015 and January 2020. We defined OSA as an apnea-hypopnea index (AHI) ≥15 events per h. EDS was described as having an Epworth Sleepiness Scale score ≥10. Major adverse cerebrovascular and cardiovascular events (MACCEs) were the primary outcome and included cardiovascular death, stroke, myocardial infarction, ischemia-driven revascularization, or hospitalization for heart failure or unstable angina.
The final study cohort comprised 1154 participants, of whom 398 (34.5%) had EDS, and 607 (52.6%) had OSA. During the median follow-up period of 2.9 years (interquartile range 1.5, 3.6), OSA was associated with a significantly increased risk of MACCEs in patients without EDS (adjusted hazard ratio (HR) = 1.42, 95% CI: 1.01-2.02, = 0.046), but not in patients with EDS (adjusted hazard ratio HR = 1.05, 95% CI: 0.67-1.66, = 0.84).
OSA was associated with an elevated risk of MACCEs In ACS patients without EDS but not those with EDS. Therefore, screening for OSA should be performed in ACS patients without EDS, and future trials should prioritize such high-risk patients.
NCT03362385, https://clinicaltrials.gov/study/NCT03362385.
日间过度嗜睡（EDS）是阻塞性睡眠呼吸暂停（OSA）患者中常见的症状。然而，EDS对急性冠状动脉综合征（ACS）合并OSA患者预后的影响尚不清楚。因此，本研究旨在探讨有无EDS的ACS患者中OSA与心血管事件之间的关联。
本队列研究前瞻性纳入了2015年6月至2020年1月住院期间接受心肺多导睡眠图检查的符合条件的ACS患者。我们将OSA定义为呼吸暂停低通气指数（AHI）≥15次/小时。EDS定义为Epworth嗜睡量表评分≥10分。主要不良脑血管和心血管事件（MACCEs）为主要结局，包括心血管死亡、中风、心肌梗死、缺血驱动的血运重建或因心力衰竭或不稳定型心绞痛住院。
最终研究队列包括1154名参与者，其中398名（34.5%）有EDS，607名（52.6%）有OSA。在2.9年的中位随访期（四分位间距1.5，3.6）内，OSA与无EDS患者发生MACCEs的风险显著增加相关（调整后风险比（HR）=1.42，95%CI：1.01-2.02，P=0.046），但与有EDS患者无关（调整后风险比HR =1.05，95%CI：0.67-1.66，P =0.84）。
在无EDS的ACS患者中，OSA与MACCEs风险升高相关，但在有EDS的患者中并非如此。因此，应在无EDS的ACS患者中进行OSA筛查，未来试验应优先关注此类高危患者。
NCT03362385，https://clinicaltrials.gov/study/NCT03362385 。
