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Chen X, Zhen L, Ai H, Que B, Fan J, Wang X, Yan Y, Li S, Zhang Z, Zhou Y, Gong W, Nie S. Prognostic implications of obstructive sleep apnea in patients with acute coronary syndrome stratified by homocysteine level: a prospective cohort study. Respir Res 2023; 24:313. [PMID: 38098080 PMCID: PMC10722678 DOI: 10.1186/s12931-023-02627-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Sporadic studies have examined the impact of OSA on ACS patients by homocysteine (Hcy) level. This study attempted to comprehensively evaluate the effects of the interaction between Hcy and OSA on long-term cardiovascular outcomes in ACS patients. METHODS In this prospective, large-scale cohort study, 2160 patients admitted for ACS were recruited to undergo overnight sleep monitoring. OSA was diagnosed when apnea-hypopnea index ≥ 15 events/h. Patients with normohomocysteinemia (NHcy) were defined as having serum Hcy ≤ 15 μmol/L, and the others had hyperhomocysteinemia (HHcy). The primary endpoint was major adverse cerebrocardiovascular event (MACCE), a composite of cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization and hospitalization for unstable angina and heart failure. RESULTS A total of 1553 eligible ACS patients (average age: 56.3 ± 10.5 years) were enrolled, among which 819 (52.7%) had OSA, and 988 (63.6%) were with NHcy. OSA did not significantly affect the level of Hcy. During a median follow-up of 2.9 (1.6, 3.5) years, after adjustment for clinical confounders, OSA was associated with increased risk for MACCE occurrence versus non-OSA ones in ACS patients with NHcy (adjusted hazard ratio [HR] = 1.36, 95% confidence interval [CI] 1.02-1.83, P = 0.039), but not in those with HHcy (adjusted HR = 0.92, 95%CI 0.62-1.36, P = 0.668). There was an absence of interaction between homocysteine level and OSA in relation to MACCE (interaction P = 0.106). CONCLUSIONS OSA was independently associated with worse prognosis in ACS patients with NHcy. Our study emphasized the necessity to identify potential presence of OSA in such a population. TRIAL REGISTRATION ClinicalTrials.gov; Number: NCT03362385; URL: www. CLINICALTRIALS gov .
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Affiliation(s)
- Xiuhuan Chen
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Lei Zhen
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Hui Ai
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Bin Que
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Jingyao Fan
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Xiao Wang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Yan Yan
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Siyi Li
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Zekun Zhang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Yun Zhou
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Wei Gong
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China.
| | - Shaoping Nie
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China.
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Desai R, Mellacheruvu SP, Akella SA, Mohammed AS, Saketha P, Mohammed AA, Hussain M, Bavanasi A, Gummadi J, Sunkara P. Major Adverse Cardiac and Cerebrovascular Events in Geriatric Patients with Obstructive Sleep Apnea: An Inpatient Sample Analysis. Med Sci (Basel) 2023; 11:69. [PMID: 37987324 PMCID: PMC10660682 DOI: 10.3390/medsci11040069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with an increased risk of major cardiac and cerebrovascular events (MACCE). However, data on the burden and predictors of MACCE in geriatric patients with OSA (G-OSA) remain limited. METHODS Using the National Inpatient Sample from 2018, we identified G-OSA admissions (age ≥ 65 years) and divided them into non-MACCE vs. MACCE (all-cause mortality, stroke, acute myocardial infarction, and cardiac arrest). We compared the demographics and comorbidities in both cohorts and extracted the odds ratio (multivariate analysis) of MACCE and associated in-hospital mortality. RESULTS Out of 1,141,120 geriatric obstructive sleep apnea G-OSA admissions, 9.9% (113,295) had MACCE. Males, Asians, or the Pacific Islander/Native American race, and patients from the lowest income quartile revealed a higher MACCE rate. Significant clinical predictors of MACCE in elderly OSA patients on multivariable regression analysis in decreasing odds were pulmonary circulation disease (OR 1.47, 95% CI 1.31-1.66), coagulopathy (OR 1.43, 95% CI 1.35-1.50), peripheral vascular disease (OR 1.34, 95% CI 1.28-1.40), prior sudden cardiac arrest (OR 1.34, 95% CI 1.11-1.62), prior myocardial infarction (OR 1.27, 95% CI 1.22-1.33), fluid and electrolyte imbalances (OR 1.25, 95% CI 1.20-1.29), male sex (OR 1.22, 95% CI-1.18-1.26), hyperlipidemia (OR 1.20, 95% CI 1.16-1.24), low household income (OR 1.19, CI 1.13-1.26), renal failure (OR 1.15, 95% CI 1.12-1.19), diabetes (OR 1.14, 95% CI 1.10-1.17), metastatic cancer (OR 1.14, 95% CI 1.03-1.25), and prior stroke or TIA (OR 1.12, 95% CI 1.07-1.17) (All p value < 0.05). CONCLUSIONS This study emphasizes the significant association between obstructive sleep apnea (OSA) and major cardiac and cerebrovascular events (MACCE) in the geriatric population. Among the elderly OSA patients, a substantial 9.9% were found to have MACCE, with specific demographics like males, Asian or Pacific Islander/Native American individuals, and those from the lowest income quartile being particularly vulnerable. The study sheds light on several significant clinical predictors, with pulmonary circulation disease, coagulopathy, and peripheral vascular disease topping the list. The highlighted predictors provide valuable insights for clinicians, allowing for better risk stratification and targeted interventions in this vulnerable patient cohort. Further research is essential to validate these findings and inform how tailored therapeutic approaches for geriatric OSA patients can mitigate MACCE risk. CLINICAL IMPLICATIONS Elderly individuals with a high risk for MACCE should undergo routine OSA screening using tools like the sensitive STOP-BANG Questionnaire. Implementing CPAP treatment can enhance cardiovascular outcomes in these patients.
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Affiliation(s)
- Rupak Desai
- Independent Researcher, Atlanta, GA 30033, USA;
| | | | - Sai Anusha Akella
- Department of Internal Medicine, Kakatiya Medical College, Warangal 506007, India;
| | - Adil Sarvar Mohammed
- Department of Internal Medicine, Central Michigan University, Saginaw, MI 48602, USA
| | - Pakhal Saketha
- Department of Internal Medicine, Bhaskar Medical College, Hyderabad 500075, India;
| | - Abdul Aziz Mohammed
- Department of Internal Medicine, Kamineni Institute of Medical Sciences, Narketpally 508254, India; (A.A.M.); (M.H.)
| | - Mushfequa Hussain
- Department of Internal Medicine, Kamineni Institute of Medical Sciences, Narketpally 508254, India; (A.A.M.); (M.H.)
| | - Aamani Bavanasi
- Department of Internal Medicine, Captain James A Lovell FHCC/Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA;
| | - Jyotsna Gummadi
- Department of Medicine, MedStar Franklin Square Medical Center, Baltimore, MD 21237, USA;
| | - Praveena Sunkara
- Department of Internal Medicine, Medstar Medical Group, Charlotte Hall, MD 20622, USA;
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