Impact of High Risk for Obstructive Sleep Apnea on Survival after Acute Coronary Syndrome: Insights from the ERICO Registry.
BACKGROUND
Obstructive sleep apnea (OSA) is a very often clinical condition that can be associated with high mortality risk, particularly in coronary heart disease (CHD). The diagnosis of OSA is not always accessible via the gold-standard method polysomnography.


OBJECTIVE
To evaluate long-term influence of the high risk for OSA on fatal and non-fatal outcomes after acute coronary syndrome (ACS) in the Acute Coronary Syndrome Registry Strategy (ERICO) Study using the Berlin questionnaire as a surrogate.


METHODS
Berlin questionnaire, a screening questionnaire for OSA, was applied in 639 cases of ACS 30 days after the index event. Cox regression proportional-hazards model was used to calculate the hazard ratio (HR) of all-cause, cardiovascular and CHD (myocardial infarction) mortality, as well as, the combined endpoint of fatal or recurrent non-fatal CHD.


RESULTS
The high-risk group for OSA had higher frequencies of previous personal/family history of CHD and diabetes, in addition to a poorer event-free survival, as compared to the low-risk group (p-log-rank=0.03). The HR for fatal or recurrent non-fatal CHD was 4.26 (95% confidence interval, 1.18 - 15.36) in patients at high risk for OSA compared to those at low risk for OSA after a 2.6-year mean follow-up.


CONCLUSIONS
Using Berlin questionnaire, we were able to identify high risk for OSA as an independent predictor of non-fatal reinfarction or CHD mortality in post-ACS individuals in a long-term follow-up.
Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil.
Flavia C
FC
Maia
Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil.
Alessandra C
AC
Goulart
HC, FM, USP, São Paulo, SP, Brazil.
Luciano F
LF
Drager
Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil.
Henrique L
HL
Staniak
Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil.
Itamar de Souza
IS
Santos
Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil.
Paulo Andrade
PA
Lotufo
Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil.
Isabela M
IM
Bensenor
D054058:Acute Coronary Syndrome / Q000150:complications / Q000401:mortality*; D000368:Aged; D001938:Brazil; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors