Impact of obstructive sleep apnea on long-term cardiovascular outcomes in acute coronary syndrome with different treatment strategies

ZHANG Ying; LIU Hong-tao; HAO Wen; GUO Ying-ying; QIU Yu-yao; LIU Xiao-chen; WANG Bin; GUO Qian; WANG Xiao; GUO Cai-xia; NIE Shao-ping

doi:10.3969/j.issn.1672-5301.2025.06.012

Abstract：Objective To evaluate the impact of obstructive sleep apnea(OSA)on long-term cardiovascular outcomes in acute coronary syndrome(ACS)patients among patients with or without revascularization.Methods This is a prospective cohort study.Patients who were hospitalized for ACS and underwent portable sleep monitoring after clinical stabilization were consecutively enrolled in Beijing Anzhen Hospital between June 2015 and January 2020.Patients were divided into revascularization and non-revascularization groups.Basing on apnea hypopnea index,patients were categorized into OSA(apnea hypopnea index ≥15 events/hour)and non-OSA(apnea hypopnea index＜15 events/hour).The primary endpoint was MACCE.Multivariable Cox regression analyses were performed to determine independent predictors of MACCE in ACS patients with or without revascularization.Results A total of 1,927 patients who met inclusion criteria were enrolled.Mean±SD patient age was(56.4±10.5)years and 84.5％were male.52.6％had OSA and 69.4％underwent revascularization.During a 2.9-years follow up,the risk of MACCE was similar in patients with or without revascularization.Although the prevalence of OSA was lower in patients without revascularization than in those with revascularization(54.3％vs.48.8％,P=0.026),OSA independently predicted the incidence of MACCE only in patients without revascularization(HR=1.861;95％CI 1.239-2.796;P=0.003),but not in patients with revascularization(HR=1.135;95％CI 0.882-1.460;P=0.324).The incremental risk in non-revascularization group was attributable to more hospitalization for unstable angina(14.2％vs.8.6％;HR=1.896;95％CI 1.124-3.199;P=0.016).Conclusions For patients with ACS,OSA was independently associated with higher risk of recurrent cardiovascular events among patients without revascularization but not among patients undergoing revascularization.