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. 2023 Jun;46(6):663-673.
doi: 10.1002/clc.24020. Epub 2023 Apr 14.

Comorbid obstructive sleep apnea is associated with adverse cardiovascular outcomes in female patients with acute coronary syndrome complicating metabolic syndrome

Bin Wang  1   2 , Xiaogang Liu  1   2   3 , Wen Hao  1   2 , Jingyao Fan  1   2 , Bin Que  1   2 , Hui Ai  1   2 , Xiao Wang  1   2 , Shaoping Nie  1   2
Affiliations

Comorbid obstructive sleep apnea is associated with adverse cardiovascular outcomes in female patients with acute coronary syndrome complicating metabolic syndrome

Bin Wang et al. Clin Cardiol. 2023 Jun.

Abstract

Background: Obstructive sleep apnea (OSA) and metabolic syndrome (MetS) are each increasingly common in patients with acute coronary syndrome (ACS). Whether OSA increases cardiovascular consequences in ACS patients with MetS has not been investigated.

Hypothesis: OSA increases cardiovascular risk in ACS patients with MetS. We aimed to examine the association between OSA and cardiovascular consequences in ACS patients with MetS.

Methods: In this prospective cohort study, we consecutive recruited 2160 ACS patients who underwent portable sleep breathing monitoring. OSA is defined as an apnea-hypopnea index (AHI) ≥ 15 events/h. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure.

Results: A total of 1927 patients with ACS were enrolled. Among them, 1486 (77.1%) had MetS and 1014 (52.6%) had OSA. During 2.9 years of follow-up, the cumulative incidence of MACCE was similar between OSA and non-OSA groups in patients with MetS (21.9% vs. 17.9%, adjusted hazard ratio [HR] = 1.29 95% confidence interval [CI]: 0.99-1.67, p = .06) and patients without MetS (24.4% vs. 17.3%, adjusted HR = 1.21 95% CI: 0.73-2.03, p = .46). Patients with MetS and OSA had a significantly higher risk of MACCE than patients with MetS and without OSA in women (27.8% vs. 18.1%, adjusted HR = 1.70, 95% CI: 1.01-3.09, p = .04) but not in men (21.0% vs. 17.9%, adjusted HR = 1.19, 95% CI: 0.91-1.59, p = .21).

Conclusions: In hospitalized ACS patients with MetS, comorbid OSA was associated with increased risk of cardiovascular consequences among women.

Keywords: acute coronary syndrome; metabolic syndrome; obstructive sleep apnea.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flowchart. ACS, acute coronary syndrome; CPAP, continuous positive airway pressure; MetS, metabolism syndrome; OSA, obstructive sleep apnea.
Figure 2
Figure 2
Cumulative incidence of hospitalization for MACCE, unstable angina, and composite for cardiac events by sex and OSA categories in ACS patients with MetS. Kaplan–Meier estimates and fully‐adjusted HR for hospitalization for MACCE (A, D), unstable angina (B, E), and Composite for cardiac events (C, F) between OSA and non‐OSA groups in women (A, B, C) and men (D, E, F). Composite for cardiac events (cardiovascular death, myocardial infarction ischemia‐driven revascularization, or hospitalization for unstable angina or heart failure); HR, hazard ratio; OSA, obstructive sleep apnea.
See this image and copyright information in PMC

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