Background
Methods
Study design and population
Overnight sleep study
Procedures and management
Follow-up and outcomes
Statistical analysis
Results
Baseline characteristics
Variables | All (N = 1927) | Prior stroke (n = 207) | Non-prior stroke (n = 1720) | ||||
---|---|---|---|---|---|---|---|
OSA (n = 121) | Non-OSA(n = 86) | P-value | OSA (n = 893) | Non-OSA(n = 827) | P value | ||
Demographics | |||||||
Age, y | 56.4 ± 10.5 | 62.0 ± 8.9 | 61.6 ± 9.6 | 0.80 | 55.8 ± 10.6 | 55.7 ± 10.3 | 0.78 |
Male | 1629 (84.5%) | 100 (82.6%) | 65 (75.6%) | 0.21 | 786 (88.0%) | 678 (82.0%) | < 0.001 |
BMI, kg/m2 | 27.1 ± 3.6 | 27.9 ± 3.7 | 25.8 ± 3.2 | < 0.001 | 28.1 ± 3.5 | 26.0 ± 3.4 | < 0.001 |
Neck, circumference, cm | 41 (38–43) | 41 (39 to 44) | 39 (37 to 41) | < 0.001 | 41.5 (39 to 44) | 40 (38 to 42) | < 0.001 |
Waist, circumference, cm | 99 (93 to 105) | 101 (97 to 109) | 96 (90 to 100.3) | < 0.001 | 101 (95 to 108) | 97 (91 to 102) | < 0.001 |
Systolic BP, mm Hg | 126 (117–138) | 127 (118 to 145) | 130 (120 to 142) | 0.47 | 126 (117 to 138) | 126 (116 to 137) | 0.26 |
Diastolic BP, mm Hg | 76 (70–84) | 76 (70 to 83.5) | 75 (68.8 to 81.0) | 0.64 | 78 (70 to 86) | 75 (69 to 83) | < 0.001 |
Medical history | |||||||
Diabetes mellitus | 609 (31.6%) | 50 (58.1%) | 36 (41.9%) | 0.46 | 262 (29.3%) | 254 (30.7%) | 0.53 |
Hypertension | 1247 (64.7) | 103 (85.1%) | 68 (79.1%) | 0.26 | 588 (65.8%) | 488 (59.0%) | 0.003 |
Hyperlipidemia | 637 (33.1) | 52 (43.0%) | 31 (36.0%) | 0.32 | 291 (32.6%) | 263 (31.8%) | 0.73 |
Prior MI | 316 (16.4) | 23 (19.0%) | 14 (16.3%) | 0.61 | 154 (17.2%) | 125 (15.1%) | 0.23 |
Previous PCI | 399 (20.7) | 33 (27.3%) | 16 (18.6%) | 0.15 | 201 (22.5%) | 149 (18.0%) | 0.021 |
Previous CABG | 29 (1.5) | 1 (0.8%) | 1 (1.2%) | 0.81 | 17 (1.9%) | 10 (1.2%) | 0.25 |
Smoking | 0.73 | 0.08 | |||||
No | 953 (49.5%) | 76 (62.8%) | 52 (60.5%) | 442 (49.5%) | 383 (46.3%) | ||
Yes | 974 (50.5%) | 45 (37.2%) | 34 (39.5%) | 451 (50.5%) | 444 (53.7%) | ||
Baseline tests | |||||||
Glucose, mmol/L | 5.98 (5.32 to 7.51) | 6.10 (5.47 to 8.24) | 6.10 (5.28 to 7.44) | 0.24 | 6.04 (5.33 to 7.61) | 5.90 (5.29 to 7.29) | 0.17 |
Hemoglobin A1C, % | 6.10 (5.60 to 7.00) | 6.30 (5.60 to 7.38) | 6.10 (5.70 to 7.00) | 0.35 | 6.10 (5.70 to 7.00) | 6.00 (5.60 to 6.90) | 0.028 |
Triglyceride, mmol/L | 1.51 (1.10 to 2.20) | 1.44 (1.07 to 1.90) | 1.38 (1.11 to 1.89) | 0.53 | 1.59 (1.13 to 2.31) | 1.47 (1.05 to 2.18) | 0.16 |
Total Cholesterol, mmol/L | 4.12 (3.47 to 4.91) | 3.93 (3.40 to 4.50) | 3.92 (3.46 to 4.80) | 0.47 | 4.18 (3.52 to 4.94) | 4.09 (3.41 to 4.96) | 0.35 |
HDL-C, mmol/L | 1.00 (0.86 to 1.16) | 0.98 (0.87 to 1.14) | 1.01 (0.84 to 1.17) | 0.80 | 0.98 (0.85 to 1.13) | 1.02 (0.87 to 1.18) | 0.003 |
LDL-C, mmol/L | 2.43 (1.90 to 3.09) | 2.34 (1.92 to 2.88) | 2.31 (1.90 to 3.00) | 0.72 | 2.46 (1.95 to 3.11) | 2.42 (1.83 to 3.11) | 0.17 |
Hs-CRP, mmol/L | 2.06 (0.82 to 6.13) | 2.35 (0.86 to 9.25) | 1.50 (0.65 to 3.98) | 0.24 | 2.53 (1.05 to 7.24) | 1.44 (0.61 to 4.69) | < 0.001 |
LVEF, % | 61.0 (56.0 to 65.0) | 62.0 (55.5 to 65.5) | 58.0 (66.0 to 66.0) | 0.86 | 60.0 (55.0 to 65.0) | 62.0 (57.0 to 66.0) | 0.010 |
Diagnosis | 0.96 | 0.013 | |||||
Unstable angina | 1132 (58.7%) | 74 (61.2%) | 54 (62.8%) | 498 (55.8%) | 506 (61.2%) | ||
NSTEMI | 365 (18.9%) | 23 (19.0%) | 15 (17.4%) | 168 (18.8%) | 159 (19.2%) | ||
STEMI | 430 (22.3%) | 24 (19.8%) | 17 (19.8%) | 227 (25.4%) | 162 (19.6%) | ||
Procedures | |||||||
Vessels | 0.64 | 0.19 | |||||
0 | 170 (8.8%) | 9 (7.4%) | 7 (7.8%) | 69 (7.7%) | 85 (10.3%) | ||
1 | 512 (26.6%) | 21 (17.4%) | 19 (22.1%) | 240 (26.9%) | 232 (28.1%) | ||
≥ 2 | 1245 (64.6%) | 91 (75.2%) | 60 (69.8%) | 584 (65.4%) | 510 (61.7%) | ||
PCI | 1209 (62.7%) | 72 (59.5%) | 52 (60.5%) | 0.89 | 595 (66.6%) | 490 (59.3%) | 0.002 |
CABG | 130 (6.7%) | 14 (11.6%) | 10 (11.6%) | 0.99 | 45 (5.0%) | 61 (7.4%) | 0.044 |
Medications on discharge | |||||||
Aspirin | 1877 (97.4%) | 114 (94.2%) | 81 (94.2%) | 0.99 | 873 (97.8%) | 809 (97.8%) | 0.93 |
P2Y12 inhibitors | 1768 (91.7%) | 110 (90.9%) | 80 (93.0%) | 0.59 | 828 (92.7%) | 750 (90.7%) | 0.13 |
β-blockers | 1488 (77.2%) | 92 (76.0%) | 52 (60.5%) | 0.016 | 707 (79.2%) | 637 (77.0%) | 0.28 |
ACEIs/ARBs | 1195 (62.0%) | 82 (67.8%) | 55 (64.0%) | 0.57 | 583 (65.3%) | 475 (57.4%) | 0.001 |
Statins | 1897 (98.4%) | 119 (98.3%) | 83 (96.5%) | 0.40 | 878 (98.3%) | 817 (98.8%) | 0.42 |
Results of the sleep study
Variables | All (N = 1297) | Prior stroke (n = 207) | Non-prior stroke (n = 1720) | P value | OSA (n = 893) | Non-OSA(n = 827) | P value |
---|---|---|---|---|---|---|---|
OSA (n = 121) | Non-OSA(n = 86) | ||||||
AHI, events/h | 16.0 (8.0 to 30.0) | 29.6 (23.1 to 40.7) | 7.6 (4.2 to 10.2) | < 0.001 | 28.8 (20.6 to 42.30 | 7.7 (4.1 to 10.8) | < 0.001 |
ODI, events/h | 16.2 (8.8 to 28.6) | 27.3 (21.3 to 36.4) | 8.9 (5.9 to 11.5) | < 0.001 | 27.6 (20.1 to 40.0) | 8.5 (4.8 to 11.9) | < 0.001 |
Min SpO2, % | 85 (81 to 88) | 80 (76 to 85) | 87 (85 to 89) | < 0.001 | 83 (78 to 86) | 88 (84 to 90) | < 0.001 |
Mean SpO2, % | 94 (93 to 95) | 93 (92 to 94) | 94 (93 to 95) | < 0.001 | 93 (92 to 94) | 94 (93 to 95) | < 0.001 |
T90 SpO2 < 90% | 2.3 (0.4 to 10.0) | 7.7 (3.0 to 23.0) | 1.0 (0.2 to 5.2) | < 0.001 | 6.0 (2.0 to 15.0) | 0.5 (0.0 to 3.0) | < 0.001 |
Epworth Sleepiness Scale | 7.0 (4.0 to 11.0) | 8.6 (6.0 to 12.0) | 6.8 (3.0 to 11) | 0.036 | 8.3 (5.0 to 12.0) | 7.0 (3.0–10.0) | < 0.001 |
Outcomes in the overall population according to OSA and prior stroke
Outcomes of OSA versus non-OSA patients stratified by prior stroke
Variables | Prior stroke (n = 207) | Non-prior stroke (n = 1720) | ||||||
---|---|---|---|---|---|---|---|---|
Unadjusted HR (95% CI) | P-value | Adjusted HRa (95% CI) | P-value | Unadjusted HR (95% CI) | P value | Adjusted HRa (95% CI) | P value | |
MACCE | 1.93 (1.10 to 3.36) | 0.021 | 2.04 (1.13 to 3.69) | 0.018 | 1.26 (1.01 to 1.56) | 0.040 | 1.21 (0.96 to 1.52) | 0.10 |
Cardiovascular death | 1.15 (0.32 to 4.06) | 0.83 | 1.09 (0.28 to 4.23) | 0.90 | 1.23 (0.54 to 2.80) | 0.63 | 1.05 (0.44 to 2.49) | 0.91 |
Myocardial infarction | 4.15 (0.48 to 35.6) | 0.19 | 6.61 (0.61 to 71.56) | 0.12 | 1.55 (0.85 to 2.84) | 0.15 | 1.44 (0.76 to 2.74) | 0.27 |
Stroke | 3.22 (0.91 to 11.4) | 0.07 | 3.03 (0.82 to 11.25) | 0.10 | 0.83 (0.40 to 1.75) | 0.62 | 0.84 (0.39 to 1.83) | 0.67 |
Ischemia-driven revascularization | 1.57 (0.63 to 3.89) | 0.33 | 1.62 (0.62 to 4.23) | 0.33 | 1.32 (0.94 to 1.85) | 0.11 | 1.27 (0.89 to 1.82) | 0.19 |
Hospitalization for unstable angina | 1.37 (0.65 to 2.87) | 0.41 | 1.42 (0.65 to 3.11) | 0.38 | 1.25 (0.97 to 1.61) | 0.09 | 1.21 (0.92 to 1.58) | 0.17 |
Hospitalization for heart failure | 1.16 (0.19 to 6.98) | 0.87 | 0.96 (0.14 to 6.80) | 0.97 | 0.95 (0.36 to 2.53) | 0.92 | 0.81 (0.29 to 2.26) | 0.69 |
Composite of major cardiovascular eventsb | 2.73 (1.17 to 6.38) | 0.020 | 2.84 (1.17 to 6.93) | 0.022 | 1.29 (0.86 to 1.95) | 0.23 | 1.19 (0.77 to 1.84) | 0.44 |
All-cause death | 0.67 (0.22 to 1.99) | 0.47 | 0.67 (0.21 to 2.17) | 0.50 | 1.01 (0.51 to 1.99) | 0.99 | 0.86 (0.42 to 1.75) | 0.68 |
All repeat revascularization | 1.65 (0.74 to 3.65) | 0.22 | 1.87 (0.81 to 4.34) | 0.14 | 1.18 (0.89 to 1.55) | 0.26 | 1.11 (0.83 to 1.49) | 0.49 |