American journal of preventive cardiology · 2026
Phenogroup-based stratification of cardiovascular risk in obstructive sleep apnea.
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Kosasih Anastasya Maria, Ou Yihui, Koo Chieh-Yang, Drager Luciano F, Zhang Junjie, Sethi Rishi, Li Ruogu, Ho Hee-Hwa, Loo Germaine, Ong Thun-How, Sia Ching-Hui, Chen Zhengfeng, Sim Hui-Wen, Kang Giap-Swee, Sorokin Vitaly, Wong Serene, Chew Nicholas, Chan Mark Y, Richards Arthur Mark, Chen Shao-Liang, Tan Huay-Cheem, Barbe Ferran, Tam Wilson W, Lee Chi-Hang
Аннотация
BACKGROUND: Obstructive sleep apnea (OSA) exhibits substantial phenotypic heterogeneity, but its prognostic relevance in patients with coronary artery disease (CAD) undergoing revascularization remains uncertain.
METHODS: We pooled data from two prospective cohorts of CAD patients undergoing percutaneous coronary intervention or coronary artery bypass grafting (n = 2318). Major adverse cardiac and cerebrovascular events (MACCE; cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and unplanned revascularization) were assessed over a mean follow-up of 1.9 ± 1.1 years. Latent class analysis using nine clinical variables identified phenogroups. Associations between OSA (apnea-hypopnea index ≥15) and MACCE were evaluated using Cox regression.
RESULTS: Three phenogroups were identified: (1) Younger-Sleepy-Hypoxia (42.2%), (2) Cardiorenal-Metabolic (30.9%), and (3) Old-Lean-Chinese (26.9%). OSA prevalence was similar across groups (45.5%, 50.7%, and 47.8%). The overall incidence of MACCE was 11.4% and did not differ significantly across phenogroups (p = 0.127). OSA was associated with increased MACCE risk in the overall cohort (adjusted HR 1.55, 95% CI 1.20-2.00; p < 0.001). In phenogroup analyses, this association was significant in phenogroup 1 (adjusted HR 1.57, 95% CI 1.04-2.36; p = 0.030), borderline in phenogroup 2 (adjusted HR 1.55, 95% CI 0.98-2.43; p = 0.059), and not significant in phenogroup 3 (adjusted HR 1.32, 95% CI 0.81-2.16; p = 0.263).
CONCLUSIONS: In revascularized CAD patients, OSA was associated with increased cardiovascular risk in the overall cohort, with heterogeneity across phenogroups. These findings support phenogroup-based risk stratification, pending external validation.
METHODS: We pooled data from two prospective cohorts of CAD patients undergoing percutaneous coronary intervention or coronary artery bypass grafting (n = 2318). Major adverse cardiac and cerebrovascular events (MACCE; cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and unplanned revascularization) were assessed over a mean follow-up of 1.9 ± 1.1 years. Latent class analysis using nine clinical variables identified phenogroups. Associations between OSA (apnea-hypopnea index ≥15) and MACCE were evaluated using Cox regression.
RESULTS: Three phenogroups were identified: (1) Younger-Sleepy-Hypoxia (42.2%), (2) Cardiorenal-Metabolic (30.9%), and (3) Old-Lean-Chinese (26.9%). OSA prevalence was similar across groups (45.5%, 50.7%, and 47.8%). The overall incidence of MACCE was 11.4% and did not differ significantly across phenogroups (p = 0.127). OSA was associated with increased MACCE risk in the overall cohort (adjusted HR 1.55, 95% CI 1.20-2.00; p < 0.001). In phenogroup analyses, this association was significant in phenogroup 1 (adjusted HR 1.57, 95% CI 1.04-2.36; p = 0.030), borderline in phenogroup 2 (adjusted HR 1.55, 95% CI 0.98-2.43; p = 0.059), and not significant in phenogroup 3 (adjusted HR 1.32, 95% CI 0.81-2.16; p = 0.263).
CONCLUSIONS: In revascularized CAD patients, OSA was associated with increased cardiovascular risk in the overall cohort, with heterogeneity across phenogroups. These findings support phenogroup-based risk stratification, pending external validation.