The Effect of Sleep Apnea on Cardiovascular Events in Different Acute Coronary Syndrome Phenotypes
Por:
Zapater, A, Sanchez-de-la-Torre, M, Benitez, ID, Targa, A, Bertran, S, Torres, G, Aldoma, A, De Batlle, J, Abad, J, Duran-Cantolla, J, Cabriada-Nuno, V, Mediano, O, Masdeu, MJ, Munoz, C, Masa, JF, De la Pena, M, Mayos, M, Coloma, R, Montserrat, JM, Chiner, E, Minguez, O, Pascual, L, Cortijo, A, Martinez, D, Dalmases, M, McEvoy, RD, Barbe, F, Sanchez-de-la-Torre, A, Spanish Sleep Network
Publicada:
15 dic 2020
Resumen:
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 event.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.
Filiaciones:
Zapater, A:
Hosp Arnau Vilanova, Inst Recerca Biomed Lleida IRBLleida, Grp Med Precis Enfermedades Cron, Lleida, Spain
Ctr Invest Biomed Red Enfermedades Resp CIBERES, Madrid, Spain
Sanchez-de-la-Torre, M:
Hosp Arnau Vilanova, Inst Recerca Biomed Lleida IRBLleida, Grp Med Precis Enfermedades Cron, Lleida, Spain
Ctr Invest Biomed Red Enfermedades Resp CIBERES, Madrid, Spain
Benitez, ID:
Hosp Arnau Vilanova, Inst Recerca Biomed Lleida IRBLleida, Invest Traslac Med Resp, Lleida, Spain
Ctr Invest Biomed Red Enfermedades Resp CIBERES, Madrid, Spain
Targa, A:
Hosp Arnau Vilanova, Inst Recerca Biomed Lleida IRBLleida, Invest Traslac Med Resp, Lleida, Spain
Bertran, S:
Hosp Arnau Vilanova, Inst Recerca Biomed Lleida IRBLleida, Invest Traslac Med Resp, Lleida, Spain
Torres, G:
Hosp Arnau Vilanova, Inst Recerca Biomed Lleida IRBLleida, Invest Traslac Med Resp, Lleida, Spain
Ctr Invest Biomed Red Enfermedades Resp CIBERES, Madrid, Spain
Aldoma, A:
Hosp Arnau Vilanova, Inst Recerca Biomed Lleida IRBLleida, Dept Cardiol, Lleida, Spain
De Batlle, J:
Hosp Arnau Vilanova, Inst Recerca Biomed Lleida IRBLleida, Invest Traslac Med Resp, Lleida, Spain
Ctr Invest Biomed Red Enfermedades Resp CIBERES, Madrid, Spain
Abad, J:
Ctr Invest Biomed Red Enfermedades Resp CIBERES, Madrid, Spain
Hosp Univ Germans Trias & Pujol Barcelona, Dept Neumol, Barcelona, Spain
Duran-Cantolla, J:
Ctr Invest Biomed Red Enfermedades Resp CIBERES, Madrid, Spain
Hosp Univ Araba, Serv Invest Org Sanitaria Integrada OSI, Inst Invest Sanitaria ISS Bioaraba, Vitoria, Spain
Cabriada-Nuno, V:
Hosp Univ Cruces, Dept Neumol, Bizkaia, Spain
Mediano, O:
Ctr Invest Biomed Red Enfermedades Resp CIBERES, Madrid, Spain
Hosp Univ Guadalajara, Dept Neumol, Guadalajara, Spain
Masdeu, MJ:
Ctr Invest Biomed Red Enfermedades Resp CIBERES, Madrid, Spain
Univ Autonoma Barcelona, Inst Invest & Innovacio Parc Tauli I3PT, Hosp Univ Parc Tauli, Dept Neumol & Sueno, Sabadell, Spain
Munoz, C:
Hosp Univ Burgos, Dept Neumol, Burgos, Spain
Masa, JF:
Ctr Invest Biomed Red Enfermedades Resp CIBERES, Madrid, Spain
Hosp San Pedro Alcantara, Dept Neumol, Caceres, Spain
De la Pena, M:
Hosp Univ Son Espases, Inst Invest Sanitaria Palma IdisPa, Anal Clin & Serv Resp, Palma De Mallorca, Spain
Mayos, M:
Ctr Invest Biomed Red Enfermedades Resp CIBERES, Madrid, Spain
Hosp Santa Creu & Sant Pau, Unidad Sueno, Dept Med Resp, Barcelona, Spain
Coloma, R:
Hosp Gen Univ Albacete, Dept Neumol, Albacete, Spain
Montserrat, JM:
Ctr Invest Biomed Red Enfermedades Resp CIBERES, Madrid, Spain
Hosp Clin Barcelona, Dept Neumol, Barcelona, Spain
Chiner, E:
Hosp Univ St Joan dAlacant, Dept Neumol, Alicante, Spain
Minguez, O:
Hosp Arnau Vilanova, Inst Recerca Biomed Lleida IRBLleida, Invest Traslac Med Resp, Lleida, Spain
Pascual, L:
Hosp Arnau Vilanova, Inst Recerca Biomed Lleida IRBLleida, Invest Traslac Med Resp, Lleida, Spain
Cortijo, A:
Hosp Arnau Vilanova, Inst Recerca Biomed Lleida IRBLleida, Invest Traslac Med Resp, Lleida, Spain
Martinez, D:
Hosp Arnau Vilanova, Inst Recerca Biomed Lleida IRBLleida, Invest Traslac Med Resp, Lleida, Spain
Dalmases, M:
Hosp Arnau Vilanova, Inst Recerca Biomed Lleida IRBLleida, Invest Traslac Med Resp, Lleida, Spain
Ctr Invest Biomed Red Enfermedades Resp CIBERES, Madrid, Spain
McEvoy, RD:
Flinders Univ S Australia, Coll Med & Publ Hlth, Adelaide Inst Sleep Hlth, Adelaide, SA, Australia
Barbe, F:
Hosp Arnau Vilanova, Inst Recerca Biomed Lleida IRBLleida, Invest Traslac Med Resp, Lleida, Spain
Ctr Invest Biomed Red Enfermedades Resp CIBERES, Madrid, Spain
Sanchez-de-la-Torre, A:
Hosp Arnau Vilanova, Inst Recerca Biomed Lleida IRBLleida, Invest Traslac Med Resp, Lleida, Spain
Ctr Invest Biomed Red Enfermedades Resp CIBERES, Madrid, Spain
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