Impact of Obstructive Sleep Apnea and Triglyceride Glucose Index on Cardiovascular Events in Acute Coronary Syndrome Patients: A Post-Hoc Analysis of the OSA–ACS Study

Abstract

Background: Obstructive sleep apnea (OSA) is highly prevalent in patients with acute coronary syndrome (ACS). The triglyceride glucose (TyG) index is considered closely linked to cardiovascular risk. However, the relationship between OSA, TyG index, and cardiovascular outcomes in ACS patients remains unclear. Hence, this study aimed to examine the effects of OSA and the TyG index on cardiovascular outcomes in ACS patients. Methods: This post-hoc analysis included 1853 patients from the OSA–ACS project, a single-center prospective cohort study that enrolled ACS patients admitted between January 2015 and December 2019. OSA was defined as an apnea–hypopnea index of ≥15 events/hour. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE). Multivariable Cox regression models were used to evaluate the impact of OSA on cardiovascular events across the TyG index categories. Results: OSA was present in 52.5% of the participants, with a mean TyG index of 9.02 ± 0.68. Over a median follow-up of 35.1 (19.0–43.5) months, OSA was significantly associated with a heightened risk of MACCE (adjusted hazard ratio (aHR): 1.556; 95% confidence interval (CI): 1.040–2.326; p = 0.031) in the high TyG group within the fully adjusted model, along with elevated risk of hospitalization for unstable angina (aHR: 1.785; 95% CI: 1.072–2.971; p = 0.026). No significant associations were observed between OSA and MACCE in the low and moderate TyG groups. Conclusions: This analysis demonstrates that OSA significantly increases the risk of adverse cardiovascular events in ACS patients with a high TyG index, underscoring the importance of routine OSA screening in these high-risk ACS patients to optimize cardiovascular risk stratification and personalize treatment strategies. The Clinical Trial Registration: NCT03362385, https://clinicaltrials.gov/expert-search?term=NCT03362385.

Keywords

• acute coronary syndrome
• insulin resistance
• obstructive sleep apnea
• triglyceride glucose index