Association of obstructive sleep apnea with cardiovascular events in acute coronary syndrome patients with dual risk of remnant cholesterol and low-grade inflammation: a post-hoc analysis of the OSA-ACS study.
Ding Xu, Yuekun Zhang, Lei Zhen, Wen Hao, Wen Zheng, Yan Yan, Xiao Wang, Shaoping Nie
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Abstract
Purpose: Obstructive sleep apnea (OSA) is a recognized cardiovascular risk factor, yet the benefits of intervention remain uncertain due to the heterogeneity among OSA patients. We aimed to explore the association of OSA with cardiovascular outcomes in acute coronary syndrome (ACS) patients with dual risk of elevated remnant cholesterol (RC) and low-grade inflammation indicated by high-sensitivity C-reactive protein (hs-CRP).
Methods: This study is a post-hoc analysis of OSA-ACS project enrolled 1833 ACS patients from January 2015 to December 2019, who underwent a sleep study, categorized into four groups by median levels of RC and hs-CRP: RC and low-grade inflammation risk (RCIR), low-grade inflammation risk (LDIR), RC risk (RCR), and no residual risk. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) including cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina or heart failure, and ischemia-driven revascularization. Cox proportional hazards models were used to assess the association between OSA and cardiovascular events.
Results: After a median follow-up of 35.13 months, OSA significantly increased the risk of MACCE (adjusted hazard ratio [HR] 1.58, 95% confidence interval [CI] 1.01-2.47; p = 0.045) and stroke (adjusted HR 5.23, 95% CI 1.19-22.99; p = 0.027) in the RCIR group. In the RCIR group, the log-transformed AHI (Log-AHI) and ODI (Log-ODI) were both significantly associated with an increased risk of MACCE, with adjusted hazard ratios of 1.711 (95% CI: 1.092-2.679; p = 0.019) and 1.813 (95% CI: 1.039-3.163; p = 0.036), respectively. Moreover, log-transformed nadir SaO2 (Log-Nadir SaO2) demonstrated a significant inverse association with MACCE risk (adjusted HR: 0.033; 95% CI: 0.001-0.769; p = 0.034).
Conclusions: OSA is prevalent and more severe in ACS patients with dual risk of elevated RC and low-grade inflammation, significantly increasing MACCE and stroke risk, highlighting the need for routine screening and comprehensive management to reduce cardiovascular risk.
期刊介绍：
The journal Sleep and Breathing aims to reflect the state of the art in the international science and practice of sleep medicine. The journal is based on the recognition that management of sleep disorders requires a multi-disciplinary approach and diverse perspectives. The initial focus of Sleep and Breathing is on timely and original studies that collect, intervene, or otherwise inform all clinicians and scientists in medicine, dentistry and oral surgery, otolaryngology, and epidemiology on the management of the upper airway during sleep.
Furthermore, Sleep and Breathing endeavors to bring readers cutting edge information about all evolving aspects of common sleep disorders or disruptions, such as insomnia and shift work. The journal includes not only patient studies, but also studies that emphasize the principles of physiology and pathophysiology or illustrate potentially novel approaches to diagnosis and treatment. In addition, the journal features articles that describe patient-oriented and cost-benefit health outcomes research. Thus, with peer review by an international Editorial Board and prompt English-language publication, Sleep and Breathing provides rapid dissemination of clinical and clinically related scientific information. But it also does more: it is dedicated to making the most important developments in sleep disordered breathing easily accessible to clinicians who are treating sleep apnea by presenting well-chosen, well-written, and highly organized information that is useful for patient care.
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