Andrea Zapater1,2, Manuel Sánchez-de-la-Torre1,2, Ivan David Benítez3,2, Adriano Targa3, Sandra Bertran3, Gerard Torres3,2, Albina Aldomà4, Jordi De Batlle3,2, Jorge Abad2,5, Joaquín Duran-Cantolla2,6, Valentin Cabriada-Nuño7, Olga Mediano2,8, María José Masdeu2,9, Carmen Muñoz10, Juan Fernando Masa2,11, Mónica De la Peña12, Mercè Mayos2,13, Ramon Coloma14, Josep María Montserrat2,15, Eusebi Chiner16, Olga Mínguez3, Lydia Pascual3, Anunciación Cortijo3, Dolores Martínez3, Mireia Dalmases3,2, R Doug McEvoy17, Ferran Barbé3,2, Alicia Sánchez-de-la-Torre3,2. 1. Grupo de Medicina de Precisión en Enfermedades Crónicas. 2. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain. 3. Investigación Traslacional en Medicina Respiratoria, and. 4. Departamento de Cardiología, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomedica de Lleida (IRBLleida), Lleida, Spain. 5. Departamento de Neumología, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain. 6. Servicio de Investigación Organización Sanitaria Integrada (OSI), Hospital Universitario Araba, Instituto de Investigación Sanitaria (ISS) Bioaraba, Vitoria, Spain. 7. Departamento de Neumología, Hospital Universitario Cruces, Bizkaia, Spain. 8. Departamento de Neumología, Hospital Universitario de Guadalajara, Guadalajara, Spain. 9. Departamento de Neumología y Sueño, Hospital Universitari Parc Taulí, Institut Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Sabadell, Spain. 10. Departamento de Neumología, Hospital Universitario de Burgos, Burgos, Spain. 11. Departamento de Neumología, Hospital San Pedro Alcántara, Cáceres, Spain. 12. Análisis Clínico y Servicios Respiratorios, Hospital Universitari Son Espases, Institut de Investigació Sanitaria de Palma (IdisPa), Palma de Mallorca, Spain. 13. Unidad del Sueño, Departamento de Medicina Respiratoria, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 14. Departamento de Neumología, Hospital General Universitario de Albacete, Spain. 15. Departamento de Neumología, Hospital Clinic, Barcelona, Spain. 16. Departamento de Neumología, Hospital Universitari Sant Joan d'Alacant, Alicante, Spain and. 17. Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
Abstract
Rationale: Obstructive sleep apnea (OSA) is associated with increased cardiovascular disease (CVD) risk. Conversely, OSA has not been shown to increase recurrent cardiovascular events in patients with acute coronary syndrome (ACS). This lack of homogeneity could suggest that the deleterious effect of OSA and its contribution to CVD could depend on specific patient profiles. Objectives: To evaluate the effect of OSA on cardiovascular risk for patients with different ACS phenotypes. Methods: Post hoc analysis of the ISAACC (Continuous Positive Airway Pressure in Patients with ACS and OSA) study, including 1,701 patients admitted for ACS (NCT01335087). To evaluate the presence of OSA (apnea-hypopnea index ≥ 15 events · h-1), all patients underwent polygraphy. Patients were followed up for a minimum period of 1 year. We performed nonsupervised clustering using latent class analysis to identify subgroups of patients on the basis of 12 clinical factors associated with cardiovascular risk. The effect of OSA on recurrent cardiovascular event risk was evaluated for each phenotype identified.Measurements and Main Results: Two phenotypes were identified: patients without previous heart disease and without previous ACS ("no-previous-CVD" phenotype; 81%) and patients with previous heart disease and previous ACS ("previous-CVD" phenotype; 19%). The median (interquartile range) at follow-up was 2.67 (3.8) years. For the no-previous-CVD phenotype, the effect of OSA showed an adjusted hazard ratio (95% confidence interval) of 1.54 (1.06-2.24; P value = 0.02), whereas for the previous-CVD phenotype, the effect of OSA showed an adjusted hazard ratio of 0.69 (0.46-1.04; P value = 0.08).Conclusions: For patients with ACS and a specific phenotype, OSA is associated with an increased risk of recurrent cardiovascular events. These patients are mainly characterized by no previous heart disease and admission for a first ACS occurrence.
Rationale: Obstructive sleep apnea (OSA) is associated with increased cardiovascular disease (CVD) risk. Conversely, OSA has not been shown to increase recurrent cardiovascular events in patients with acute coronary syndrome (ACS). This lack of homogeneity could suggest that the deleterious effect of OSA and its contribution to CVD could depend on specific patient profiles. Objectives: To evaluate the effect of OSA on cardiovascular risk for patients with different ACS phenotypes. Methods: Post hoc analysis of the ISAACC (Continuous Positive Airway Pressure in Patients with ACS and OSA) study, including 1,701 patients admitted for ACS (NCT01335087). To evaluate the presence of OSA (apnea-hypopnea index ≥ 15 events · h-1), all patients underwent polygraphy. Patients were followed up for a minimum period of 1 year. We performed nonsupervised clustering using latent class analysis to identify subgroups of patients on the basis of 12 clinical factors associated with cardiovascular risk. The effect of OSA on recurrent cardiovascular event risk was evaluated for each phenotype identified.Measurements and Main Results: Two phenotypes were identified: patients without previous heart disease and without previous ACS ("no-previous-CVD" phenotype; 81%) and patients with previous heart disease and previous ACS ("previous-CVD" phenotype; 19%). The median (interquartile range) at follow-up was 2.67 (3.8) years. For the no-previous-CVD phenotype, the effect of OSA showed an adjusted hazard ratio (95% confidence interval) of 1.54 (1.06-2.24; P value = 0.02), whereas for the previous-CVD phenotype, the effect of OSA showed an adjusted hazard ratio of 0.69 (0.46-1.04; P value = 0.08).Conclusions: For patients with ACS and a specific phenotype, OSA is associated with an increased risk of recurrent cardiovascular events. These patients are mainly characterized by no previous heart disease and admission for a first ACS occurrence.
Authors: Andrea Zapater; Geoffroy Solelhac; Alicia Sánchez-de-la-Torre; Esther Gracia-Lavedan; Ivan David Benitez; Gerard Torres; Jordi De Batlle; José Haba-Rubio; Mathieu Berger; Jorge Abad; Joaquín Duran-Cantolla; Amaia Urrutia; Olga Mediano; María José Masdeu; Estrella Ordax-Carbajo; Juan Fernando Masa; Mónica De la Peña; Mercé Mayos; Ramon Coloma; Josep María Montserrat; Eusebi Chiner; Olga Mínguez; Lydia Pascual; Anunciación Cortijo; Dolores Martínez; Mireia Dalmases; Chi-Hang Lee; R Doug McEvoy; Ferran Barbé; Raphael Heinzer; Manuel Sánchez-de-la-Torre Journal: Front Med (Lausanne) Date: 2022-06-27