title: Suspicion of obstructive sleep apnea by Berlin Questionnaire predicts events in patients with acute coronary syndrome.
abstract: BACKGROUND
  From a mechanistic standpoint, obstructive sleep apnea (OSA) may further disturb cardiovascular homeostasis in the setting of acute coronary syndrome (ACS).
  
  
  OBJECTIVE
  We sought to investigate if a standardized clinical diagnosis of OSA, in acute coronary syndrome patients, predicts the risk of cardiovascular events during hospitalization.
  
  
  METHODS
  In a prospective cohort study, a group of 200 patients diagnosed with ACS between September 2005 and November 2007 were stratified by the Berlin Questionnaire (BQ) regarding the risk for OSA (high or low risk). We tested if the subgroup of high risk for OSA was prone to a higher frequency of cardiovascular events. The primary endpoint evaluated was a composite outcome of cardiovascular death, recurrent cardiac ischemic events, acute pulmonary edema and stroke during hospitalization.
  
  
  RESULTS
  Ninety four (47%) patients assessed by the BQ were likely to have OSA. High risk for OSA was associated with a non-significant higher mortality (4.25% vs 0.94%; p=0.189), but a significant higher incidence of composite cardiovascular events (18.08% vs 6.6%; p=0.016). In the logistic regression model, multivariate predictors of composite cardiovascular events were age (OR= 1.048; 95% CI 1.008 to 1.090; p=0.019), left ventricular ejection fraction (OR= 0.954; 95% CI 0.920 to 0.989; p=0.010), and higher risk for OSA (OR= 3.657; 95% CI 1.216 to 10.996; p=0.021).
  
  
  CONCLUSIONS
  The use of a simple and validated questionnaire (BQ) to identify patients with higher risk for OSA may help in the prediction of cardiovascular outcome during hospitalization. Moreover, our data suggests that OSA is very common in patients with ACS.
authors.affiliation: Departamento de Cardiologia, Universidade Federal de Sergipe, Aracaju, SE, Brazil.
authors.forename: Eryca Vanessa S de
authors.initials: EV
authors.lastname: Jesus
authors.forename: Euvaldo B
authors.initials: EB
authors.lastname: Dias-Filho
authors.forename: Bethania de M
authors.initials: Bde M
authors.lastname: Mota
authors.forename: Luiz de
authors.initials: Ld
authors.lastname: Souza
authors.forename: Celi
authors.initials: C
authors.lastname: Marques-Santos
authors.forename: João Bosco G
authors.initials: JB
authors.lastname: Rocha
authors.forename: Joselina L M
authors.initials: JL
authors.lastname: Oliveira
authors.forename: Antônio C S
authors.initials: AC
authors.lastname: Sousa
authors.forename: José Augusto
authors.initials: JA
authors.lastname: Barreto-Filho
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000209:etiology*; D001938:Brazil / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000175:diagnosis; D011795:Surveys and Questionnaires