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...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2019-05-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/7/1/e000737.full |
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| author | Jingyao Fan Shaoping Nie Xiao Wang Yunhui Du Changsheng Ma Xinliang Ma Yongxiang Wei |
| author_facet | Jingyao Fan Shaoping Nie Xiao Wang Yunhui Du Changsheng Ma Xinliang Ma Yongxiang Wei |
| author_sort | Jingyao Fan |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-7135bca4f76443e89c25c11b1374117a |
| institution | Kabale University |
| issn | 2052-4897 |
| language | English |
| publishDate | 2019-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Diabetes Research & Care |
| spelling | doaj-art-7135bca4f76443e89c25c11b1374117a2024-12-15T20:20:08ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972019-05-017110.1136/bmjdrc-2019-000737Clinical significance of obstructive sleep apnea in patients with acute coronary syndrome in relation to diabetes statusJingyao Fan0Shaoping Nie1Xiao Wang2Yunhui Du3Changsheng Ma4Xinliang Ma5Yongxiang Wei6Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaCenter for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaInner Mongolia Key Laboratory of Endoscopic Digestive Diseases, Endoscopy Center, Inner Mongolia People’s Hospital, Hohhot, Inner Mongolia Autonomous Region, ChinaBeijing Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, ChinaBeijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, ChinaDepartment of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USADepartment of Otolaryngology Head & Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaObjective 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.https://drc.bmj.com/content/7/1/e000737.full |
| spellingShingle | Jingyao Fan Shaoping Nie Xiao Wang Yunhui Du Changsheng Ma Xinliang Ma Yongxiang Wei Clinical significance of obstructive sleep apnea in patients with acute coronary syndrome in relation to diabetes status BMJ Open Diabetes Research & Care |
| title | Clinical significance of obstructive sleep apnea in patients with acute coronary syndrome in relation to diabetes status |
| title_full | Clinical significance of obstructive sleep apnea in patients with acute coronary syndrome in relation to diabetes status |
| title_fullStr | Clinical significance of obstructive sleep apnea in patients with acute coronary syndrome in relation to diabetes status |
| title_full_unstemmed | Clinical significance of obstructive sleep apnea in patients with acute coronary syndrome in relation to diabetes status |
| title_short | Clinical significance of obstructive sleep apnea in patients with acute coronary syndrome in relation to diabetes status |
| title_sort | clinical significance of obstructive sleep apnea in patients with acute coronary syndrome in relation to diabetes status |
| url | https://drc.bmj.com/content/7/1/e000737.full |
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