Association of obstructive sleep apnea with cardiovascular events in acute coronary syndrome patients with dual risk of remnant cholesterol and low-grade inflammation: a post-hoc analysis of the OSA-ACS study.

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Sleep and Breathing Pub Date : 2025-03-08 DOI:10.1007/s11325-025-03281-8

Ding Xu, Yuekun Zhang, Lei Zhen, Wen Hao, Wen Zheng, Yan Yan, Xiao Wang, Shaoping Nie

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引用次数: 0

Abstract

Purpose: Obstructive sleep apnea (OSA) is a recognized cardiovascular risk factor, yet the benefits of intervention remain uncertain due to the heterogeneity among OSA patients. We aimed to explore the association of OSA with cardiovascular outcomes in acute coronary syndrome (ACS) patients with dual risk of elevated remnant cholesterol (RC) and low-grade inflammation indicated by high-sensitivity C-reactive protein (hs-CRP).

Methods: This study is a post-hoc analysis of OSA-ACS project enrolled 1833 ACS patients from January 2015 to December 2019, who underwent a sleep study, categorized into four groups by median levels of RC and hs-CRP: RC and low-grade inflammation risk (RCIR), low-grade inflammation risk (LDIR), RC risk (RCR), and no residual risk. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) including cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina or heart failure, and ischemia-driven revascularization. Cox proportional hazards models were used to assess the association between OSA and cardiovascular events.

Results: After a median follow-up of 35.13 months, OSA significantly increased the risk of MACCE (adjusted hazard ratio [HR] 1.58, 95% confidence interval [CI] 1.01-2.47; p = 0.045) and stroke (adjusted HR 5.23, 95% CI 1.19-22.99; p = 0.027) in the RCIR group. In the RCIR group, the log-transformed AHI (Log-AHI) and ODI (Log-ODI) were both significantly associated with an increased risk of MACCE, with adjusted hazard ratios of 1.711 (95% CI: 1.092-2.679; p = 0.019) and 1.813 (95% CI: 1.039-3.163; p = 0.036), respectively. Moreover, log-transformed nadir SaO2 (Log-Nadir SaO2) demonstrated a significant inverse association with MACCE risk (adjusted HR: 0.033; 95% CI: 0.001-0.769; p = 0.034).

Conclusions: OSA is prevalent and more severe in ACS patients with dual risk of elevated RC and low-grade inflammation, significantly increasing MACCE and stroke risk, highlighting the need for routine screening and comprehensive management to reduce cardiovascular risk.

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伴有残余胆固醇和低度炎症双重风险的急性冠状动脉综合征患者，阻塞性睡眠呼吸暂停与心血管事件的关联：OSA-ACS研究的事后分析

目的：阻塞性睡眠呼吸暂停（OSA）是公认的心血管危险因素，但由于OSA患者的异质性，干预的益处仍不确定。我们旨在探讨OSA与急性冠状动脉综合征（ACS）患者心血管结局的关系，这些患者存在残余胆固醇（RC）升高和高敏c反应蛋白（hs-CRP）指示的低度炎症的双重风险。方法：本研究对2015年1月至2019年12月期间纳入的1833例ACS患者进行了一项睡眠研究，根据RC和hs-CRP的中位数水平将其分为4组：RC和低度炎症风险（RCIR）、低度炎症风险（LDIR）、RC风险（RCR）和无剩余风险。主要终点是主要心脑血管不良事件（MACCE），包括心源性死亡、心肌梗死、中风、因不稳定型心绞痛或心力衰竭住院以及缺血驱动的血运重建术。采用Cox比例风险模型评估OSA与心血管事件之间的关系。结果：中位随访35.13个月后，OSA显著增加MACCE的风险(校正风险比[HR] 1.58, 95%可信区间[CI] 1.01-2.47；p = 0.045)和中风(调整后HR 5.23, 95% CI 1.19-22.99；p = 0.027)。在RCIR组中，对数转化AHI （Log-AHI）和ODI （Log-ODI）均与MACCE风险增加显著相关，校正风险比为1.711 (95% CI: 1.092-2.679；p = 0.019)和1.813 (95% CI: 1.039-3.163；P = 0.036)。此外，对数变换的最低点SaO2 （Log-Nadir SaO2）与MACCE风险呈显著负相关(调整后HR: 0.033；95% ci: 0.001-0.769；p = 0.034)。结论：OSA在具有RC升高和低度炎症双重风险的ACS患者中普遍存在且更为严重，显著增加MACCE和卒中风险，强调需要常规筛查和综合管理以降低心血管风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Sleep and Breathing 医学-呼吸系统

CiteScore

5.20

自引率

4.00%

发文量

222

审稿时长

3-8 weeks

期刊介绍： The journal Sleep and Breathing aims to reflect the state of the art in the international science and practice of sleep medicine. The journal is based on the recognition that management of sleep disorders requires a multi-disciplinary approach and diverse perspectives. The initial focus of Sleep and Breathing is on timely and original studies that collect, intervene, or otherwise inform all clinicians and scientists in medicine, dentistry and oral surgery, otolaryngology, and epidemiology on the management of the upper airway during sleep. Furthermore, Sleep and Breathing endeavors to bring readers cutting edge information about all evolving aspects of common sleep disorders or disruptions, such as insomnia and shift work. The journal includes not only patient studies, but also studies that emphasize the principles of physiology and pathophysiology or illustrate potentially novel approaches to diagnosis and treatment. In addition, the journal features articles that describe patient-oriented and cost-benefit health outcomes research. Thus, with peer review by an international Editorial Board and prompt English-language publication, Sleep and Breathing provides rapid dissemination of clinical and clinically related scientific information. But it also does more: it is dedicated to making the most important developments in sleep disordered breathing easily accessible to clinicians who are treating sleep apnea by presenting well-chosen, well-written, and highly organized information that is useful for patient care.