The Effect of Sleep Apnea on Cardiovascular Events in Different Acute Coronary Syndrome Phenotypes
Authors: Andrea Zapater, Manuel Sánchez-de-la-Torre, Ivan David Benítez, Adriano Targa, Sandra Bertran, Gerard Torres, Albina Aldomà, Jordi De Batlle, Jorge Abad, Joaquín Duran-Cantolla, Valentin Cabriada-Nuño, Olga Mediano, María José Masdeu, Carmen Muñoz, Juan Fernando Masa, Mónica De la Peña, Mercè Mayos, Ramon Coloma, Josep María Montserrat, Eusebi Chiner, Olga Mínguez, Lydia Pascual, Anunciación Cortijo, Dolores Martínez, Mireia Dalmases, R. Doug McEvoy, Ferran Barbé, Alicia Sánchez-de-la-Torre, Laura Abad, Aida Muñoz, Elisabet Zamora, Ignacio Vicente, Sandra Inglés, Carlos Egea, Jaime Marcos, Almudena Fernández, Chechu Amibilia, Amaia Urrutia, Sonia Castro, Leyre Serrano, Marina Florés, Estefanía Galera, Anna Mas, Montserrat Martínez, Maricel Arbonés, Silvia Ortega, Alicia Martín, Jose Miguel Román-Sánchez, Mª Isabel Valiente-Diaz, Mª Esther Viejo-Ayuso, Concepción Rodríguez-García, Laura Vigil, Enriqueta Ramírez, María Piñar, Elisabet Martínez, Estrella Ordax, Blanca Barriuso, Jaime Corral, Francisco Javier Gómez de Terreros Caro, Antonia Barceló, Paloma Giménez, Miguel Carrera, Ana Mª Fortuna, Patricia Peñacoba, Abel Jesús Martínez García, Sergio García Castillo, Lara Navas, Onintza Garmendia, José Sancho, Salvador Perelló, Gemma Rubinós
Journal: American Journal of Respiratory and Critical Care Medicine (2020)

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.