Central sleep apnea after acute coronary syndrome and association with ticagrelor use

Study objectives: By modifying the apneic threshold, the antiplatelet agent ticagrelor could promote central sleep apnea hypopnea syndrome (CSAHS). We aimed to assess the association between CSAHS and ticagrelor administration. Methods: Patients were prospectively included within 1 year after acute coronary syndrome (ACS), if they had no heart failure (and left ventricular ejection fraction >= 45%) and no history of sleep apnea. After an overnight sleep study, patients were classified as "normal" with apnea hypopnea index (AHI) < 15, "CSAHS patients" with AHI >= 15 mostly with central sleep apneas, and "obstructive sleep apnea hypopnea syndrome (OSAHS) patients" with AHI >= 15 mostly with obstructive sleep apneas. Results: We included 121 consecutive patients (mean age 56.8 +/- 10.8, 88% men, mean body mass index 28.3 +/- 4.4 kg/m(2), left ventricular ejection fraction 56 +/- 5%, at a mean of 67 +/- 60 days (median 40 days, interquartile range: 30-80 days) after ACS. In total, 49 (45.3%) patients had AHI >= 15 (27 [22.3%] CSAHS %, 22 [18.2%] OSAHS). For 80 patients receiving ticagrelor, 24 (30%) had CSAHS with AHI >= 15, and for 41 patients not taking ticagrelor, only 3 (7.3%) had CSAHS with AHI >= 15 (chi-square = 8, p = 0.004). On multivariable analysis only age and ticagrelor administration were associated with the occurrence of CSAHS, (p = 0.0007 and p = 0.0006). Conclusion: CSA prevalence after ACS is high and seems promoted by ticagrelor administration. Results from monocentric study suggest a preliminary signal of safety. (C) 2021 Elsevier B.V. All rights reserved.