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Obesity is an excessive accumulation of fat that can impair health. Because the direct measurement of body fat is difficult to perform, a number of anthropometric measures have been employed as surrogates, of which BMI is the most commonly used. However, its usefulness has been questioned as a BMI in the overweight and mildly obese range is associated with improved survival and fewer cardiovascular events than a BMI in the normal range, a phenomenon known as the 'obesity paradox'. Waist circumference, waist-to-hip ratio, and waist-to-height ratio take into consideration body-fat distribution, especially abdominal obesity, and seem to predict cardiovascular risk better than does BMI.

Obstructive sleep apnea (OSA) is characterized by upper airway collapse and airflow reduction despite respiratory effort, resulting in intermittent hypoxia and arousals, leading to a cascade of hemodynamic, autonomic, inflammatory, and metabolic effects, responsible for its adverse cardiovascular effect. OSA is an independent risk factor for cardiovascular disease, and its prevalence in patients presenting with acute coronary syndromes is up to 69%. Furthermore, OSA has been associated with increased risk of adverse events after an acute coronary syndrome. Continuous positive airway pressure is considered the mainstay of treatment of OSA and has been shown to reduce the risk of cardiovascular events. However, the proper time to start treatment in the acute setting is unknown. A prospective randomized clinical trial is currently underway to answer this question.

QRS duration and OSA were significantly associated. Severity of OSA independently predicted prolonged QRS in women but not men. Nevertheless, prolongation of QRS duration in either sex may potentiate arrhythmic risks associated with OSA.

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