Association Between Obstructive Sleep Apnea-Hypopnea Syndrome and Outcomes in Patients with Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease

Abstract

Background: Myocardial infarction in the absence of obstructive coronary artery disease (MINOCA) occurs in 5% to 10% of all patients with acute myocardial infarction. Obstructive sleep apnea-hypopnea syndrome (OSAHS) is linked to increased cardiovascular morbidity and mortality, but the relationship of OSAHS and outcomes in patients with MINOCA remains unknown. Objectives: We aimed to evaluate the association between OSAHS and clinical outcomes in patients with MINOCA.Methods and Results: Between January 2015 and December 2016, we carried out a prospective and consecutive cohort study of 583 patients with MINOCA and followed them up for three years. An apnea-hypopnea index of ≥15 events per hour recorded by polysomnography was defined as the diagnostic criterion for OSAHS. The primary end point was all-cause mortality, and the second end point was major adverse cardiovascular or cerebrovascular events (MACCE), a composite of cardiac death, nonfatal myocardial infarction, heart failure, cardiovascular-related rehospitalization, and stroke. All-cause mortality happened in 69 patients and MACCE occurred in 113 patients during the three-year follow-up. Kaplan–Meier survival curves indicated the significant relationship of OSAHS with all-cause mortality (log-rank P = 0.012) and MACCE (log-rank P = 0.002). Multivariate Cox regression analysis indicated OSAHS as an independent predictor of all-cause mortality and MACCE (adjusted hazard ratio: 1.714; 95% confidence interval (CI): 1.203–2.168; P = 0.013; and adjusted hazard ratio: 1.787; 95% CI: 1.249–2.236; P = 0.004; respectively), independent of age, sex, cardiovascular risk factors and discharge medications.Conclusions: OSAHS is independently associated with increased risk of all-cause mortality and MACCE in patients with MINOCA. Intervention and treatment should be considered to alleviate OSAHS-associated risk.

Association of Sleep-Disordered Breathing With Cardiovascular Events and Death in patients With Ischemic Heart Disease: A systematic review and meta-analysis

“…Six studies reported an increased Hazard ratio (HR) of all-cause mortality with SDB compared with controls in patients with myocardial ischemia, 13,17,26,29,30,31 with the pooled HR of 1.39(95% CI 1.12-1.73, p=0.0027) (Fig 3). There was no obvious statistical heterogeneity (Cochran Q = 7.27, p =0.2; I 2 = 31%), and no evidence of bias (Egger intercept = 0.8883, p = 0.2548).…”

“…Sixteen studies reported an increased Hazard ratio (HR) of MACCEs outcomes with SDB compared with controls in patients with myocardial ischemia, 12,13,16,18,19,20,21,22,23,24,25,26,27,28,29,30 with the combined HR of 1.66(95% CI 1.41-1.94, P< 0.0001) (Fig 2). Some evidence of statistical heterogeneity (Cochran Q = 23.00, p=0.08; I 2 = 35%) was found by pooled effect size, which might be in part attributable to 1 randomized controlled trial.…”

Association Between Obstructive Sleep Apnea-Hypopnea Syndrome and Outcomes in Patients With Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease

“…Thanks to the Jiaxing Institute of Arteriosclerotic Diseases. This manuscript has been released as a pre-print at (38).…”