The Effect of Sleep Apnea on Cardiovascular Events in Different Acute Coronary Syndrome Phenotypes
| Autor: | Zapater A, Sánchez-de-la-Torre M, Benítez ID, Targa A, Bertran S, Torres G, Aldomà A, De Batlle J, Abad J, Duran-Cantolla J, Cabriada-Nuño V, Mediano O, Masdeu MJ, Muñoz C, Masa JF, De la Peña M, Mayos M, Coloma R, Montserrat JM, Chiner E, Mínguez O, Pascual L, Cortijo A, Martínez D, Dalmases M, McEvoy RD, Barbé F, Sánchez-de-la-Torre A, Spanish Sleep Network |
|---|---|
| Rok vydání: | 2020 |
| Předmět: | |
| Zdroj: | AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE r-IIB SANT PAU: Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau Institut dInvestigació Biomèdica Sant Pau (IIB Sant Pau) r-FISABIO: Repositorio Institucional de Producción Científica Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO) r-FISABIO. Repositorio Institucional de Producción Científica instname r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau AM J RESP CRIT CARE r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante |
| ISSN: | 1073-449X |
| Popis: | 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|