Glycemic status modifies the association between obstructive sleep apnea and cardiovascular outcomes in patients with acute coronary syndrome
X Liu, M Zhang, W Hao, Q Guo, F Zhang, X Kong, Y Chen, Y Guo, S Nie, X WangAbstract
Background
Whether glycemic status modifies the association between obstructive sleep apnea (OSA) and cardiovascular outcomes in patients with acute coronary syndrome (ACS) remains largely unknown.
Objectives
To examine whether glycemic status, including prediabetes and glycemic control in diabetes, modifies the association between OSA and long-term cardiovascular outcomes in patients with ACS.
Methods
In this prospective cohort study, we recruited 2160 ACS patients undergoing portable sleep monitoring between June 2015 and January 2020. Glycemic status was classified as normoglycemia, prediabetes, or diabetes according to hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) levels, and patients with diabetes were further stratified into controlled and uncontrolled diabetes. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization or hospitalization for unstable angina or heart failure.
Results
A total of 1,848 ACS patients were included in the final analysis, 371 with normoglycemia (20.1%), 681 with prediabetes (36.9%), and 796 with diabetes, of whom 354 had controlled diabetes (19.2%) and 442 (23.9%) had uncontrolled diabetes. The median follow-up duration was 4.9 years (3.7–6.2 years). OSA was associated with a significantly higher risk of MACCE not only in patients with diabetes (aHR, 1.32; 95% CI, 1.02–1.72; P=0.04) but also in those with prediabetes compared with non-OSA (aHR, 1.36; 95% CI, 1.00–1.86; P=0.05), whereas no significant association was observed in normoglycemia. Among patients with diabetes, OSA was associated with increased MACCE risk only in those with uncontrolled diabetes (aHR, 1.48; 95% CI, 1.04–2.10; P=0.02), whereas no significant association was observed in controlled diabetes.
Conclusions
In patients with ACS, the prognostic impact of OSA varies according to glycemic status. The prognostic impact of OSA in ACS extends beyond established diabetes to individuals with prediabetes and varies according to glycemic control in diabetes. These findings highlight the importance of considering glycemic status when assessing cardiovascular risk related to OSA.Central Illustration