Association of obstructive sleep apnea with cardiovascular events in acute coronary syndrome patients with dual risk of remnant cholesterol and low-grade inflammation: a post-hoc analysis of the OSA-ACS study.

PURPOSE: Obstructive sleep apnea (OSA) is a recognized cardiovascular risk factor, yet the benefits of intervention remain uncertain due to the heterogeneity among OSA patients. We aimed to explore the association of OSA with cardiovascular outcomes in acute coronary syndrome (ACS) patients with dual risk of elevated remnant cholesterol (RC) and low-grade inflammation indicated by high-sensitivity C-reactive protein (hs-CRP).

METHODS

This study is a post-hoc analysis of OSA-ACS project enrolled 1833 ACS patients from January 2015 to December 2019, who underwent a sleep study, categorized into four groups by median levels of RC and hs-CRP: RC and low-grade inflammation risk (RCIR), low-grade inflammation risk (LDIR), RC risk (RCR), and no residual risk. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) including cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina or heart failure, and ischemia-driven revascularization. Cox proportional hazards models were used to assess the association between OSA and cardiovascular events.

RESULTS

After a median follow-up of 35.13 months, OSA significantly increased the risk of MACCE (adjusted hazard ratio [HR] 1.58, 95% confidence interval [CI] 1.01-2.47; p = 0.045) and stroke (adjusted HR 5.23, 95% CI 1.19-22.99; p = 0.027) in the RCIR group. In the RCIR group, the log-transformed AHI (Log-AHI) and ODI (Log-ODI) were both significantly associated with an increased risk of MACCE, with adjusted hazard ratios of 1.711 (95% CI: 1.092-2.679; p = 0.019) and 1.813 (95% CI: 1.039-3.163; p = 0.036), respectively. Moreover, log-transformed nadir SaO2 (Log-Nadir SaO2) demonstrated a significant inverse association with MACCE risk (adjusted HR: 0.033; 95% CI: 0.001-0.769; p = 0.034).

CONCLUSIONS

OSA is prevalent and more severe in ACS patients with dual risk of elevated RC and low-grade inflammation, significantly increasing MACCE and stroke risk, highlighting the need for routine screening and comprehensive management to reduce cardiovascular risk.