In-hospital outcomes of patients with ST-segment elevation myocardial infarction with and without obstructive sleep apnea: a nationwide propensity score-matched analysis.

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Sleep and Breathing Pub Date : 2025-03-13 DOI:10.1007/s11325-025-03297-0

Malik Alqawasmi, Alexandra Millhuff, Aman Goyal, Mohammed A Quazi, Rozi Khan, Amir H Sohail, Adeel Nasrullah, Abu Baker Sheikh

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引用次数: 0

Abstract

Introduction: Obstructive Sleep Apnea (OSA) is a prevalent condition affecting millions worldwide and is associated with an increased risk of cardiovascular complications, including ST-Elevation Myocardial Infarction (STEMI). The relationship between OSA and STEMI is complex, with OSA potentially exacerbating the severity of coronary artery disease and influencing outcomes following acute coronary events.

Methods: We retrospectively analyzed data from the National Inpatient Sample database from 2016 to 2021. Hospitalized patients aged 18 and older diagnosed with STEMI were included. Key outcomes, such as in-hospital mortality, cardiac interventions and inpatient complications, were compared between those with and without OSA. Propensity score matching was utilized to account for potential confounders and risk of complications was compared.

Results: Among 1,203,915 STEMI hospitalizations, 75,035 (6.2%) had OSA. After PSM, OSA was associated with lower in-hospital mortality (aOR: 0.82, 95% CI: 0.76-0.89, p < 0.001) but higher risks of atrial fibrillation (aOR: 1.28, 95% CI: 1.21-1.36, p < 0.001), venous thromboembolism (aOR: 1.23, 95% CI: 1.06-1.44, p = 0.009), acute kidney injury (aOR: 1.10, 95% CI: 1.04-1.16, p = 0.001), and second-degree atrioventricular block (aOR: 1.69, 95% CI: 1.33-2.15, p < 0.001). OSA patients were more likely to require non-invasive ventilation (aOR: 2.78, 95% CI: 2.48-3.11, p < 0.001) but less likely to need invasive ventilation (aOR: 0.91, 95% CI: 0.84-0.96, p < 0.001) or vasopressors (aOR: 0.77, 95% CI: 0.68-0.87, p = 0.001). Female STEMI patients with OSA had higher mortality than males (aOR: 1.17, 95% CI: 1.14-1.20, p < 0.001) and underwent fewer invasive interventions.

Conclusion: OSA in STEMI patients was associated with lower in-hospital mortality but a higher burden of complications, emphasizing the need for proactive risk stratification. The increased reliance on non-invasive ventilation highlights distinct management patterns. Additionally, the significant sex disparity, with higher mortality and fewer interventions in women, underscores the need for tailored, evidence-based strategies.

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伴有和不伴有阻塞性睡眠呼吸暂停的st段抬高型心肌梗死患者的住院结果：一项全国性倾向评分匹配分析

梗阻性睡眠呼吸暂停（OSA）是一种影响全球数百万人的普遍疾病，并与心血管并发症（包括st段抬高型心肌梗死（STEMI））的风险增加有关。OSA与STEMI之间的关系是复杂的，OSA可能会加重冠状动脉疾病的严重程度，并影响急性冠状动脉事件后的预后。方法：回顾性分析2016年至2021年国家住院患者样本数据库的数据。被诊断为STEMI的18岁及以上住院患者被纳入研究。主要结果，如住院死亡率、心脏干预和住院并发症，比较了有和没有OSA的患者。使用倾向评分匹配来解释潜在的混杂因素，并比较并发症的风险。结果：1203915例STEMI住院患者中，75035例（6.2%）患有OSA。PSM后，OSA与较低的住院死亡率相关（aOR: 0.82, 95% CI: 0.76-0.89, p）。结论：STEMI患者的OSA与较低的住院死亡率相关，但并发症负担较高，强调有必要进行主动风险分层。对无创通气的日益依赖突出了不同的管理模式。此外，严重的性别差异，妇女死亡率较高，干预措施较少，强调需要制定有针对性的循证战略。

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.