P2464Clinical significance of obstructive sleep apnea in patients with acute coronary syndrome in relation to diabetes status: insights from the OSA-ACS project

Abstract

Background: OSA is highly prevalent in patients with acute coronary syndrome (ACS) and is associated with increased risk of recurrent cardiovascular events. Studies have indicated possible interaction between OSA and diabetes mellitus (DM) in glycemic control. Whether the impact of OSA on cardiovascular outcomes after ACS may be modified by DM status remains unclear. Purpose: This study sought to investigate the association of OSA with subsequent cardiovascular events in ACS patients with or without DM. Methods: The OSA‐ACS project is a large‐scale, prospective, observational study to evaluate the effects of OSA on cardiovascular outcomes in patients presenting with ACS in the contemporary era. From June 2015 to May 2017, consecutive eligible patients admitted for ACS underwent overnight cardiorespiratory polygraphy during hospitalization. Recruited patients were categorized into OSA (AHI ≥15 events h‐1) and non‐OSA (AHI <15 events h‐1) groups. The primary endpoint was major adverse cardiovascular and cerebrovascular event (MACCE), defined as a composite of cardiovascular death, myocardial infarction, stroke, ischemia‐driven revascularization, or hospitalization for unstable angina or heart failure. This study conformed to the principles of the Declaration of Helsinki. Results: Among 804 patients, 248 (30.8%) had DM. The rate of MACCE was significantly higher in patients with versus without DM (14.5% vs. 8.1%, HR 1.88, 95% CI 1.21‐2.92, P=0.005) during a median follow‐up of 1 year (0.7‐1.7). The figure showed the Kaplan‐Meier curves for MACCE according to presence of DM and OSA. OSA was associated with 2.5 times the risk of MACCE in patients with DM (22.3% vs. 7.1% in non‐OSA group, adjusted HR 2.49, 95% CI 1.16‐5.35, P=0.019) but not in those without DM (8.5% vs. 7.7% in non‐OSA group, adjusted HR 0.94, 95% CI 0.51‐1.75, P=0.848). DM patients without OSA had a similar 1‐ year rate of MACCE as patients without DM (7.1% vs. 8.1%, adjusted HR 0.94, 95% CI 0.46‐1.95, P=0.876). Moreover, for patients with baseline glucose levels above the median of 5.9 mmol/L, presence of OSA increased the risk of incurring a MACCE (adjusted HR 2.25, 95% CI 1.17‐4.32, P=0.015), but no increased risk was found in patients with glucose levels <5.9 mmol/L (adjusted HR 0.78, 95% CI 0.36‐1.65, P=0.510). Similarly, the increased risk of MACCE in OSA patients was only observed in patients with admission levels of haemoglobin A1c above the median of 6.0% (adjusted HR 2.08, 95% CI 1.13‐3.86, P=0.019). Conclusion: ACS Patients with DM and OSA had a greater risk of MACCE at 1 year. In contrast, the prognosis of ACS patients with DM but without OSA is favorable and similar to patients without DM. Further randomized trials to explore the efficacy of OSA treatment as secondary prevention after ACS in patients with DM are highly warranted. (Figure Presented).