Clinical significance of obstructive sleep apnea in patients with acute coronary syndrome in relation to diabetes status.
Objective
The prognostic significance of obstructive sleep apnea (OSA) in patients with acute coronary syndrome (ACS) according to diabetes mellitus (DM) status remains unclear. We aimed to elucidate the association of OSA with subsequent cardiovascular events in patients with ACS with or without DM.


Research design and methods
In this prospective cohort study, consecutive eligible patients with ACS underwent cardiorespiratory polygraphy between June 2015 and May 2017. OSA was defined as an Apnea Hypopnea Index ≥15 events/hour. The primary end point was major adverse cardiovascular and cerebrovascular events (MACCEs), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure.


Results
Among 804 patients, 248 (30.8%) had DM and 403 (50.1%) had OSA. OSA was associated with 2.5 times the risk of 1 year MACCE in patients with DM (22.3% vs 7.1% in the non-OSA group; adjusted HR (HR)=2.49, 95% CI 1.16 to 5.35, p=0.019), but not in patients without DM (8.5% vs 7.7% in the non-OSA group, adjusted HR=0.94, 95% CI 0.51 to 1.75, p=0.85). Patients with DM without OSA had a similar 1 year MACCE rate as patients without DM. The increased risk of events was predominately isolated to patients with OSA with baseline glucose or hemoglobin A1c levels above the median. Combined OSA and longer hypoxia duration (time with arterial oxygen saturation <90%>22 min) further increased the MACCE rate to 31.0% in patients with DM.


Conclusions
OSA was associated with increased risk of 1 year MACCE following ACS in patients with DM, but not in non-DM patients. Further trials exploring the efficacy of OSA treatment in high-risk patients with ACS and DM are warranted.
['Wang|Xiao|X|', 'Fan|Jingyao|J|', 'Du|Yunhui|Y|', 'Ma|Changsheng|C|', 'Ma|Xinliang|X|', 'Nie|Shaoping|S|0000-0003-0664-5857', 'Wei|Yongxiang|Y|']
D054058:Acute Coronary Syndrome D000328:Adult D000368:Aged D048909:Diabetes Complications D003924:Diabetes Mellitus, Type 2 D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D017286:Polysomnography D011379:Prognosis D011446:Prospective Studies D012307:Risk Factors D020181:Sleep Apnea, Obstructive
acute coronary syndrome obstructive sleep apnea syndrome outcomes type 2 diabetes