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    • Prognostic Effect of Obstructive Sleep Apnea in Acute Coronary Syndrome Patients with Heart Failure

    Zekun Zhang,Hui Ai,Mengwen Yan, Wen Zheng, Yan,Xiao Wang,Jingyao Fan,Bin Que,Siyi Li, Ge Wang, Wei Gong,Shaoping Nie

    RESPIRATORY MEDICINE（2024）

    China Japan Friendship Hosp

    Cited 0|Views7
    Abstract
    Background and objective: Acute coronary syndrome (ACS), heart failure (HF) and obstructive sleep apnea (OSA) often overlap and interact, the impact of OSA on ACS patients with HF remains unclear. The study sought to comprehensively evaluate the effects of the interaction between OSA and HF on long-term cardiovascular outcomes in ACS patients. Methods: Between June 2015 and January 2020, patients hospitalized for ACS were prospectively enrolled and underwent portable sleep monitoring after clinically stabilization. OSA was defined as an apnea hypopnea index >= 15 events/h. HF was defined using medical records. The primary endpoint was major adverse cardiovascular and cerebrovascular event (MACCE), including death, myocardial infarction, stroke, ischemia-driven revascularization, and hospitalization for unstable angina. Results: Among all 1927 included patients, 214 (11.1 %) had HF, and 1014 (52.6 %) had OSA. For 2.9 years (1.5, 3.6 years) follow-up, OSA was independently associated with the risk of MACCE in HF patients (adjusted hazard ratio [HR], 2.11; 95%CI, 1.16-3.84; P = 0.014), but not in those without HF (adjusted HR, 1.15; 95%CI, 0.92-1.45; P = 0.228). Further analysis showed OSA exerted more prognostic effect in HF patients with preserved eject fraction (adjusted HR, 2.45; 95 % CI, 1.11-5.41; P = 0.027) than those with reduced eject fraction (adjusted HR, 1.62; 95 % CI, 0.63-4.20; P = 0.319). Conclusions: In the settings of ACS, OSA was independently associated with poor prognosis in patients with concomitant HF especially those with persevered ejection fraction. Screening and treatment for OSA are highly recommended in ACS patients with HF. Clinical trial registration: URL: www.clinicaltrails.gov; Unique Identifier: NCT03362385.
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    Key words
    Obstructive sleep apnea,Acute coronary syndrome,Heart failure,Outcome
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    【要点】：研究发现在急性冠脉综合征患者中，阻塞性睡眠呼吸暂停(OSA)与心衰(HF)的并存独立地预示着较差的心血管预后，特别是在射血分数保留的心衰患者中。
    

    【方法】：研究通过前瞻性队列研究，纳入了1927名ACS患者，使用便携式睡眠监测来确定OSA的存在，并使用医疗记录定义HF，随后进行长期随访以评估主要不良心血管和脑血管事件(MACCE)的发生情况。
    

    【实验】：在2015年6月至2020年1月间，对住院的ACS患者进行了实验，通过便携式睡眠监测确定OSA（定义为呼吸暂停低通气指数>=15次/小时），并通过医疗记录确定HF。随访2.9年，发现OSA在HF患者中独立预示MACCE风险增加（调整后的危险比率为2.11），而在无HF患者中则无此关联。进一步分析显示，在射血分数保留的心衰患者中，OSA的预后影响更大。