Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 May 1;31(5):603-615.
doi: 10.5551/jat.64517. Epub 2023 Dec 26.

The Long-Term Prognostic Role of Nighttime Resting Heart Rate in Obstructive Sleep Apnea in Patients with Acute Coronary Syndrome

Qingjie Xin  1   2   3 , Hui Ai  1   2   3 , Wei Gong  1   2   3 , Wen Zheng  1   2   3 , Xiao Wang  1   2   3 , Yan Yan  1   2   3 , Bin Que  1   2   3 , Siyi Li  1   2   3 , Zekun Zhang  1   2   3 , Xiuhuan Chen  1   2   3 , Yun Zhou  1   2   3 , Jingyao Fan  1   2   3 , Shaoping Nie  1   2   3
Affiliations

The Long-Term Prognostic Role of Nighttime Resting Heart Rate in Obstructive Sleep Apnea in Patients with Acute Coronary Syndrome

Qingjie Xin et al. J Atheroscler Thromb. .

Abstract

Aim: A close relationship exists between resting heart rate (RHR) and obstructive sleep apnea (OSA). Still, the prognostic importance of nighttime RHR in patients with acute coronary syndrome (ACS) with or without OSA remains unclear.

Methods: In this prospective cohort study, OSA was defined as an apnea-hypopnea index of ≥ 15 events/h, and the high nighttime RHR (HNRHR) was defined as a heart rate of ≥ 70 bpm. The primary endpoint was a major adverse cardiovascular and cerebrovascular event (MACCE), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for heart failure.

Results: Among the 1875 enrolled patients, the mean patient age was 56.3±10.5 years, 978 (52.2%) had OSA, and 425 (22.7%) were in HNRHR. The proportion of patients with HNRHR is higher in the OSA population than in the non-OSA population (26.5% vs. 18.5%; P＜0.001). During 2.9 (1.5, 3.5) years of follow-up, HNRHR was associated with an increased risk of MACCE in patients with OSA (adjusted HR: 1.56, 95% CI: 1.09-2.23, P=0.014), but not in patients without OSA (adjust HR: 1.13, 95% CI: 0.69-1.84, P=0.63).

Conclusions: In patients with ACS, a nighttime RHR of ≥ 70 bpm was associated with a higher risk of MACCE in those with OSA but not in those without it. This identifies a potential high-risk subgroup where heart rate may interact with the prognosis of OSA. Further research is needed to determine causative relationships and confirm whether heart rate control impacts cardiovascular outcomes in patients with ACS-OSA.

Keywords: Acute coronary syndrome; Heart rate; Obstructive sleep apnea; Prognosis.

PubMed Disclaimer

Figures

Fig.1.
Fig.1.
Study flowchart
Supplementary Fig.1.
Supplementary Fig.1.
correlation between mean night-time resting heart rate and apnea-hypopnea index
Supplementary Fig.2.
Supplementary Fig.2.
Kaplan-Meier curves for the analysis of cardiovascular events in OSA versus non-OSA group
Fig.2. High night-time resting heart rate (HNRHR) and risk of major adverse cardiovascular and cerebrovascular event (MACCE) in a) the overall population and by OSA: b) OSA; c) non-OSA
Fig.2. High night-time resting heart rate (HNRHR) and risk of major adverse cardiovascular and cerebrovascular event (MACCE) in a) the overall population and by OSA: b) OSA; c) non-OSA
Kaplan–Meier estimates for MACCE between HNRHR and non-HNRHR groups in the overall population and by OSA
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MS, M Morrell MJ, Nunez CM, Patel SR, Penzel T, Pépin JL, Peppard PE, Sinha S, Tufik S, Valentine K, Malhotra A. Estimation of the Global Prevalence and Burden of Obstructive Sleep Apnoea: A Literature-Based Analysis. The Lancet Respir Med, 2019; 7: 687-698 - PMC - PubMed
    1. Arzt M, Hetzenecker A, Lévy P. Obstructive Sleep Apnoea in Acute Coronary Syndrome: The Invisible Threat? Eur Respir J, 2017; 49(3): 1602539 - PubMed
    1. Yang SH, Xing YS, Wang ZX, Liu YB, Chen HW, Ren YF, Chen JL, Li SB, Wang ZF. Association of Obstructive Sleep Apnea With the Risk of Repeat Adverse Cardiovascular Events in Patients With Newly Diagnosed Acute Coronary Syndrome: A Systematic Review and Meta-Analysis. Ear Nose Throat J, 2021; 100: 260-270 - PubMed
    1. Wang B, Hao W, Fan J, Yan Y, Gong W, Zheng W, Que B, Ai H, Wang X, Nie S. Clinical Significance of Obstructive Sleep Apnea in Patients with Acute Coronary Syndrome with or without Prior Stroke: A Prospective Cohort Study. Eur J Med Res, 2023; 28: 107 - PMC - PubMed
    1. Hao W, Wang X, Fan J, Guo R, Gong W, Yan Y, Zheng W, Que B, Ai H, Ma C, Ma X, Nie S. Prognostic Implications of OSA in Acute Coronary Syndrome by Obesity Status. Chest, 2023; S0012369223001733 - PubMed