Respiratory Polygraphy Patterns and Risk of Recurrent Cardiovascular Events in Patients With Acute Coronary Syndrome

Frontiers in Medicine

article

Andrea Zapater¹  Geoffroy Solelhac³  Alicia Sánchez-de-la-Torre²  Esther Gracia-Lavedan²  Ivan David Benitez²  Gerard Torres²  Jordi De Batlle²  José Haba-Rubio³  Mathieu Berger³  Jorge Abad²  Joaquín Duran-Cantolla²  Amaia Urrutia⁷  Olga Mediano²  María José Masdeu²  Estrella Ordax-Carbajo^1,10  Juan Fernando Masa²  Mónica De la Peña^1,12  Mercé Mayos²  Ramon Coloma^1,14  Josep María Montserrat²  Eusebi Chiner^1,16  Olga Mínguez⁴  Lydia Pascual⁴  Anunciación Cortijo⁴  Dolores Martínez⁴  Mireia Dalmases²  Chi-Hang Lee^1,17  R. Doug McEvoy^1,18  Ferran Barbé²  Raphael Heinzer³  Manuel Sánchez-de-la-Torre¹ 

[1] Precision Medicine in Chronic Diseases, Hospital Universitari Arnau de Vilanova-Santa Maria, IRB Lleida, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida;Centro de Investigación Biomédica en Red de Enfermedades Respiratorias;Center for Investigation and Research in Sleep, Lausanne University Hospital and University of Lausanne;Translation Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria;Respiratory Department, Hospital Universitari Germans Trias i Pujol;Servicio de Investigación OSI, IIS Bioaraba, Hospital Universitario Araba;Servicio Neumologia, Hospital Universitario Cruces;Respiratory Department, Hospital Universitario de Guadalajara;Respiratory and Sleep Department, Hospital Universitari Parc Taulí, Institut Investigació i Innovació Parc Taulí ,(I3PT), Universitat Autònoma de Barcelona;Respiratory Department, Hospital Universitario de Burgos;Respiratory Department, Hospital San Pedro Alcántara;Clinic Analysis and Respiratory Services, Institut de Investigació Sanitaria de Palma, Hospital Universitari Son Espases;Sleep Unit, Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau;Respiratory Department, Hospital General Universitario de Albacete;Respiratory Department, Hospital Clinic;Respiratory Department, Hospital Universitari Sant Joan d’Alacant;Cardiovascular Research Institute, National University of Singapore;Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University;Pulmonary Department, Lausanne University Hospital and University of Lausanne

关键词: acute coronary syndrome;    cardiovascular disease;    obstructive sleep apnea;    precision medicine;    respiratory polygraphy;   

DOI  :  10.3389/fmed.2022.870906

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Introduction: Obstructive sleep apnea (OSA) severity is based on the apnea-hypopnea index (AHI). The AHI is a simplistic measure that is inadequate for capturing disease severity and its consequences in cardiovascular diseases (CVDs). Deleterious effects of OSA have been suggested to influence the prognosis of specific endotypes of patients with acute coronary syndrome (ACS). We aim to identify respiratory polygraphy (RP) patterns that contribute to identifying the risk of recurrent cardiovascular events in patients with ACS. Methods: Post hoc analysis of the ISAACC study, including 723 patients admitted for a first ACS (NCT01335087) in which RP was performed. To identify specific RP patterns, a principal component analysis (PCA) was performed using six RP parameters: AHI, oxygen desaturation index, mean and minimum oxygen saturation (SaO2), average duration of events and percentage of time with SaO2 < 90%. An independent HypnoLaus population-based cohort was used to validate the RP components. Results: From the ISAACC study, PCA showed that two RP components accounted for 70% of the variance in the RP data. These components were validated in the HypnoLaus cohort, with two similar RP components that explained 71.3% of the variance in the RP data. The first component (component 1) was mainly characterized by low mean SaO2 and obstructive respiratory events with severe desaturation, and the second component (component 2) was characterized by high mean SaO2 and long-duration obstructive respiratory events without severe desaturation. In the ISAACC cohort, component 2 was associated with an increased risk of recurrent cardiovascular events in the third tertile with an adjusted hazard ratio (95% CI) of 2.44 (1.07 to 5.56; p-value = 0.03) compared to first tertile. For component 1, no significant association was found for the risk of recurrent cardiovascular events. Conclusion: A RP component, mainly characterized by intermittent hypoxemia, is associated with a high risk of recurrent cardiovascular events in patients without previous CVD who have suffered a first ACS.

【 授权许可】

CC BY