The following is a summary of “Prognostic Implications of OSA in Acute Coronary Syndrome by Obesity Status,” published in the July 2023 issue of the Chest by Hao et al.

There is a strong correlation between OSA and adiposity. Uncertain is the effect of adiposity on the prognostic value of OSA in patients with acute coronary syndrome (ACS). Do the consequences of OSA on subsequent cardiovascular events in ACS patients differ based on their level of obesity? This is an observational cohort study. Patients between 18 and 85 hospitalized for ACS underwent portable sleep monitoring after clinical stabilization. OSA was an apnea-hypopnea index of fewer than 15 events per hour. Major adverse cardiovascular and cerebrovascular event (MACCE) was the primary endpoint, which included cardiovascular mortality, hospitalization for ACS, stroke, ischemia-driven revascularization, or hospitalization for heart failure. 

About 1,013 (52.8%) of 1,920 enrolled patients (84.5% male; mean age SD, 56.4 10.5 years) had OSA, and 718 (37.4%) were obese (BMI 28 kg/m2). During 2.9 years (1.5-3.6 years) of follow-up, the incidence of MACCE was significantly higher in obese patients than in lean patients (hazard ratio [HR], 1.29; 95% CI, 1.06-1.50; P =.003). Although the prevalence of OSA was lower in patients without obesity than in those with obesity (43.9% vs. 67.5%; P<.001), OSA independently predicted the incidence of MACCE only in patients without obesity (adjusted HR, 1.34; 95% CI, 1.03-1.75; P =.03), but not in patients with obesity (adjusted HR, 1.10; 95% CI, 0.78-1.75; P =.58. There was no significant interaction between adiposity and OSA (interaction P =.35). 

Increased hospitalizations for ACS and ischemia-driven revascularization may account for the increased risk associated with OSA in individuals without heaviness. For patients with ACS, OSA was independently associated with an increased risk of subsequent events, especially in patients who were not obese. These results emphasize the significance of identifying OSA in non-obese patients with ACS.

Source: sciencedirect.com/science/article/pii/S0012369223001733