Association of Obstructive Sleep Apnea With Cardiovascular Events in Acute Coronary Syndrome Patients With or Without Excessive Daytime Sleepiness: A Prospective Cohort Study

Abstract

Background: Excessive daytime sleepiness (EDS) is a commonly observed symptom in people with obstructive sleep apnea (OSA). However, the impact of EDS on the outcome of patients with acute coronary syndrome (ACS) and OSA is not known. Therefore, this study aimed to investigate the association between OSA and cardiovascular events in ACS patients with or without EDS. Methods: This cohort study prospectively enrolled eligible ACS patients who underwent cardiorespiratory polygraphy during hospitalization between June 2015 and January 2020. We defined OSA as an apnea–hypopnea index (AHI) ≥15 events per h. EDS was described as having an Epworth Sleepiness Scale score ≥10. Major adverse cerebrovascular and cardiovascular events (MACCEs) were the primary outcome and included cardiovascular death, stroke, myocardial infarction, ischemia-driven revascularization, or hospitalization for heart failure or unstable angina. Results: The final study cohort comprised 1154 participants, of whom 398 (34.5%) had EDS, and 607 (52.6%) had OSA. During the median follow-up period of 2.9 years (interquartile range 1.5, 3.6), OSA was associated with a significantly increased risk of MACCEs in patients without EDS (adjusted hazard ratio (HR) = 1.42, 95% CI: 1.01–2.02, p = 0.046), but not in patients with EDS (adjusted hazard ratio HR = 1.05, 95% CI: 0.67–1.66, p = 0.84). Conclusions: OSA was associated with an elevated risk of MACCEs In ACS patients without EDS but not those with EDS. Therefore, screening for OSA should be performed in ACS patients without EDS, and future trials should prioritize such high-risk patients. Clinical Trial Registration: NCT03362385, https://clinicaltrials.gov/study/NCT03362385.

Keywords

• obstructive sleep apnea
• acute coronary syndrome
• excessive daytime sleepiness
• cardiovascular events