Frontiers in Medicine (Jun 2022)

Respiratory Polygraphy Patterns and Risk of Recurrent Cardiovascular Events in Patients With Acute Coronary Syndrome

  • Andrea Zapater,
  • Andrea Zapater,
  • Geoffroy Solelhac,
  • Alicia Sánchez-de-la-Torre,
  • Alicia Sánchez-de-la-Torre,
  • Esther Gracia-Lavedan,
  • Esther Gracia-Lavedan,
  • Ivan David Benitez,
  • Ivan David Benitez,
  • Gerard Torres,
  • Gerard Torres,
  • Jordi De Batlle,
  • Jordi De Batlle,
  • José Haba-Rubio,
  • Mathieu Berger,
  • Jorge Abad,
  • Jorge Abad,
  • Joaquín Duran-Cantolla,
  • Joaquín Duran-Cantolla,
  • Amaia Urrutia,
  • Olga Mediano,
  • Olga Mediano,
  • María José Masdeu,
  • María José Masdeu,
  • Estrella Ordax-Carbajo,
  • Juan Fernando Masa,
  • Juan Fernando Masa,
  • Mónica De la Peña,
  • Mercé Mayos,
  • Mercé Mayos,
  • Ramon Coloma,
  • Josep María Montserrat,
  • Josep María Montserrat,
  • Eusebi Chiner,
  • Olga Mínguez,
  • Lydia Pascual,
  • Anunciación Cortijo,
  • Dolores Martínez,
  • Mireia Dalmases,
  • Mireia Dalmases,
  • Chi-Hang Lee,
  • R. Doug McEvoy,
  • Ferran Barbé,
  • Ferran Barbé,
  • Raphael Heinzer,
  • Raphael Heinzer,
  • Manuel Sánchez-de-la-Torre,
  • Manuel Sánchez-de-la-Torre,
  • Spanish Sleep Network,
  • Laura Abad,
  • Aida Munϸoz,
  • Elisabet Zamora,
  • Ignacio Vicente,
  • Sandra Ingleìs,
  • Carlos Egea,
  • Jaime Marcos,
  • Almudena Fernaìndez,
  • Valentin Cabriada-Nuño,
  • Sonia Castro,
  • Leyre Serrano,
  • Marina Floreìs,
  • Anna Mas,
  • Maricel Arboneìs,
  • Silvia Ortega,
  • Alicia Martiìn,
  • Jose Miguel Romaìn-Saìnchez,
  • Ma Isabel Valiente-Diaz,
  • Ma Esther Viejo-Ayuso,
  • Concepcioìn Rodriìguez-Garciìa,
  • Laura Vigil,
  • Enriqueta Ramiìrez,
  • Mariìa Pinϸar,
  • Elisabet Martiìnez,
  • Blanca Barriuso,
  • Jaime Corral,
  • Francisco Javier Goìmez de Terreros Caro,
  • Antonia Barceloì,
  • Paloma Gimeìnez,
  • Ana Ma Fortuna,
  • Patricia Penñacoba,
  • Abel Jesuìs Martiìnez-Garciìa,
  • Sergio Garciìa-Castillo,
  • Lara Navas,
  • Onintza Garmendia,
  • Joseì Sancho,
  • Salvador Perelloì,
  • Gemma Rubinoìs,
  • Rocío Gallego

DOI
https://doi.org/10.3389/fmed.2022.870906
Journal volume & issue
Vol. 9

Abstract

Read online

IntroductionObstructive sleep apnea (OSA) severity is based on the apnea-hypopnea index (AHI). The AHI is a simplistic measure that is inadequate for capturing disease severity and its consequences in cardiovascular diseases (CVDs). Deleterious effects of OSA have been suggested to influence the prognosis of specific endotypes of patients with acute coronary syndrome (ACS). We aim to identify respiratory polygraphy (RP) patterns that contribute to identifying the risk of recurrent cardiovascular events in patients with ACS.MethodsPost hoc analysis of the ISAACC study, including 723 patients admitted for a first ACS (NCT01335087) in which RP was performed. To identify specific RP patterns, a principal component analysis (PCA) was performed using six RP parameters: AHI, oxygen desaturation index, mean and minimum oxygen saturation (SaO2), average duration of events and percentage of time with SaO2 < 90%. An independent HypnoLaus population-based cohort was used to validate the RP components.ResultsFrom the ISAACC study, PCA showed that two RP components accounted for 70% of the variance in the RP data. These components were validated in the HypnoLaus cohort, with two similar RP components that explained 71.3% of the variance in the RP data. The first component (component 1) was mainly characterized by low mean SaO2 and obstructive respiratory events with severe desaturation, and the second component (component 2) was characterized by high mean SaO2 and long-duration obstructive respiratory events without severe desaturation. In the ISAACC cohort, component 2 was associated with an increased risk of recurrent cardiovascular events in the third tertile with an adjusted hazard ratio (95% CI) of 2.44 (1.07 to 5.56; p-value = 0.03) compared to first tertile. For component 1, no significant association was found for the risk of recurrent cardiovascular events.ConclusionA RP component, mainly characterized by intermittent hypoxemia, is associated with a high risk of recurrent cardiovascular events in patients without previous CVD who have suffered a first ACS.

Keywords