• Luis C L Correia, Alexandre C Souza, Guilherme Garcia, Michael Sabino, Mariana Brito, Mayara Maraux, Márcia M N Rabelo, and J Péricles Esteves.
• Medical School of Bahia, Salvador/BA, Brazil. lccorreia@terra.com.br
• Sleep. 2012 Sep 1; 35 (9): 1241-5A.

Study ObjectiveWe aimed to test the hypothesis that clinically suspected obstructive sleep apnea (OSA) independently predicts worse in-hospital outcome in patients with non-ST elevation acute coronary syndromes.DesignAt admission, individuals were evaluated for clinical probability of OSA by the Berlin Questionnaire. Primary cardiovascular endpoint was defined as the composite of death, nonfatal myocardial infarction, or refractory angina during hospitalization.SettingCoronary care unit.PatientsThere were 168 consecutive patients admitted with unstable angina or non-ST elevation acute myocardial infarction.Measurements And ResultsDuring a median hospitalization of 8 days, the incidence of cardiovascular events was 13% (12 deaths, 4 nonfatal myocardial infarctions, and 6 refractory anginas.) Incidence of the primary endpoint was 18% in individuals with high probability of OSA, compared with no events in individuals with low probability (P = 0.002). After logistic regression adjustment for the Global Registry of Acute Coronary Events (GRACE) risk score, anatomic severity of coronary disease, and hospital treatment, probability of OSA remained an independent predictor of events (odds ratio [OR] = 3.4; 95% confidence interval [CI] = 1.3 - 9.0; P = 0.015). Prognostic discrimination of the GRACE score, measured by a C-statistic of 0.72 (95% CI = 0.59-0.85), was significantly improved to 0.82 (95% CI = 0.73-0.92) after inclusion of OSA probability in the predictive model (P = 0.03).ConclusionConsidering the independent prognostic and incremental value of suspected OSA, this condition may represent an aggravating factor for patients with non-ST elevation acute coronary syndrome.

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