Adverse effect of beta-blockers in non-ST elevation acute coronary syndrome patients with obstructive sleep apnea

IF 3.4 2区 医学 Q1 CLINICAL NEUROLOGY
Zekun Zhang , Siyi Li , Ge Wang , Yun Zhou , Yan Yan , Jingyao Fan , Hui Ai , Wei Gong , Shaoping Nie
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引用次数: 0

Abstract

Background

Currently, beta-blockers are recommended for non-ST elevation acute coronary syndrome (NSTE-ACS). However, there is still a lack of studies evaluating the use of beta-blockers in patients with NSTE-ACS complicated by obstructive sleep apnea (OSA).

Methods

This is the sub-analysis of OSA-ACS project (NCT03362385), a prospective, observational study recruited ACS patients undergoing portable sleep monitoring between June 2015 and January 2020. Patients with NSTE-ACS were selected in this analysis. The primary endpoint was major adverse cardiovascular events (MACE), including cardiovascular death, myocardial infarction or ischemia-driven revascularization.

Results

After exclusion, 1452 NSTE-ACS patients were enrolled, and 75.3 % of patients received beta-blockers at discharge. The proportion of beta-blockers users in the OSA group was 77.4 % and 73.2 % in the non-OSA group, with no significant difference (P = 0.068). In OSA group, beta-blocker users had higher rate of MACE (18.2 % versus 9.0 %, adjusted hazard ratio [HR] 1.90, 95 % confidence interval [CI] 1.04–3.45, p = 0.037) but not in non-OSA group (14.1 % versus 9.9 %, adjusted HR 1.45, 95 % CI 0.80–2.62, p = 0.219). After propensity score matching, beta-blocker users were still at higher risk of MACE (19.3 % versus 9.3 %, adjusted HR 2.18, 95 % CI 1.09–4.35, p = 0.028) in OSA group, in contrast the risk was comparable in non-OSA group (13.2 % versus 9.9 %, adjusted HR 1.27, 95 % CI 0.63–2.57, p = 0.501). Sensitivity analysis was consistent with the main results. Subgroup analysis showed no significant interactions (P > 0.10, for all comparisons).

Conclusion

The administration of beta-blockers is associated with higher risk of adverse cardiovascular outcomes in NSTE-ACS patients with concomitant OSA.

Abstract Image

-受体阻滞剂对非st段抬高急性冠脉综合征合并阻塞性睡眠呼吸暂停患者的不良影响
目前,β受体阻滞剂被推荐用于非st段抬高急性冠脉综合征(NSTE-ACS)。然而,目前仍缺乏评估β受体阻滞剂在NSTE-ACS合并阻塞性睡眠呼吸暂停(OSA)患者中的应用的研究。方法:这是OSA-ACS项目(NCT03362385)的亚分析,这是一项前瞻性观察性研究,招募了2015年6月至2020年1月期间接受便携式睡眠监测的ACS患者。NSTE-ACS患者入选本分析。主要终点是主要不良心血管事件(MACE),包括心血管死亡、心肌梗死或缺血驱动的血运重建术。结果排除后,1452例NSTE-ACS患者入组,75.3%的患者在出院时接受β受体阻滞剂治疗。β受体阻滞剂使用者比例在OSA组为77.4%,在非OSA组为73.2%,差异无统计学意义(P = 0.068)。在OSA组中,β受体阻滞剂使用者有较高的MACE发生率(18.2%比9.0%,校正风险比[HR] 1.90, 95%可信区间[CI] 1.04-3.45, p = 0.037),而在非OSA组中没有(14.1%比9.9%,校正风险比1.45,95% CI 0.80-2.62, p = 0.219)。在倾向评分匹配后,β受体阻滞剂使用者在OSA组中仍有较高的MACE风险(19.3%对9.3%,校正HR 2.18, 95% CI 1.09-4.35, p = 0.028),而非OSA组的风险相当(13.2%对9.9%,校正HR 1.27, 95% CI 0.63-2.57, p = 0.501)。敏感性分析与主要结果一致。亚组分析显示无显著相互作用(P >;0.10,适用于所有比较)。结论-受体阻滞剂的使用与NSTE-ACS合并OSA患者心血管不良结局的高风险相关。
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来源期刊
Sleep medicine
Sleep medicine 医学-临床神经学
CiteScore
8.40
自引率
6.20%
发文量
1060
审稿时长
49 days
期刊介绍: Sleep Medicine aims to be a journal no one involved in clinical sleep medicine can do without. A journal primarily focussing on the human aspects of sleep, integrating the various disciplines that are involved in sleep medicine: neurology, clinical neurophysiology, internal medicine (particularly pulmonology and cardiology), psychology, psychiatry, sleep technology, pediatrics, neurosurgery, otorhinolaryngology, and dentistry. The journal publishes the following types of articles: Reviews (also intended as a way to bridge the gap between basic sleep research and clinical relevance); Original Research Articles; Full-length articles; Brief communications; Controversies; Case reports; Letters to the Editor; Journal search and commentaries; Book reviews; Meeting announcements; Listing of relevant organisations plus web sites.
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