• Wen Hao, Xiao Wang, Jingyao Fan, Ruifeng Guo, Wei Gong, Yan Yan, Wen Zheng, Bin Que, Hui Ai, Changsheng Ma, Xinliang Ma, and Shaoping Nie.
• Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
• Chest. 2023 Jul 1; 164 (1): 219230219-230.

BackgroundA close relationship exists between OSA and obesity. The impact of obesity on the prognostic significance of OSA in patients with acute coronary syndrome (ACS) remains unclear.Research QuestionDo the effects of OSA on subsequent cardiovascular events in patients with ACS vary with obesity status?Study Design And MethodsThis is a prospective cohort study. Patients 18 to 85 years of age who were hospitalized for ACS were consecutively enrolled and underwent portable sleep monitoring after clinical stabilization. OSA was defined as an apnea hypopnea index ≥ 15 events/h. The primary end point was major adverse cardiovascular and cerebrovascular event (MACCE), including cardiovascular death, hospitalization for ACS, stroke, ischemia-driven revascularization, or hospitalization for heart failure.ResultsAmong 1,920 patients enrolled (84.5% male; mean age ± SD, 56.4 ± 10.5 years), 1,013 (52.8%) had OSA, and 718 (37.4%) were obese (BMI ≥ 28 kg/m2). During 2.9 years (1.5, 3.6 years) follow-up, the incidence of MACCE was significantly higher in patients with obesity than in patients without obesity (hazard ratio [HR], 1.29; 95% CI, 1.06-1.58; P = .013). Although the prevalence of OSA was lower in patients without obesity than in those with obesity (43.9% vs 67.5%; P < .001), OSA independently predicted the incidence of MACCE only in patients without obesity (adjusted HR, 1.34; 95% CI, 1.03-1.75; P = .03), but not in patients with obesity (adjusted HR, 1.10; 95% CI, 0.78-1.55; P = .58). No significant interaction between obesity and OSA was noted (P for interaction = .35). The incremental risk associated with OSA in patients without obesity might be explained by more hospitalization for ACS and ischemia-driven revascularization.InterpretationFor patients with ACS, OSA was independently associated with an increased risk of subsequent events, particularly among patients without obesity. These findings highlight the importance of identifying OSA in nonobese patients with ACS.Clinical Trial RegistrationClinicalTrials.gov; No.: NCT03362385; URL: www.Clinicaltrialsgov.Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

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