Abstract 2030: Suspicion of Obstructive Sleep Apnea by Berlin Questionnaire Predicts Cardiovascular Events in Patients with Acute Coronary Syndrome
Background - Obstructive sleep apnea (OSA) is an emerging and aggravating risk factor in the setting of acute coronary syndrome (ACS).
Study objectives: The aim of this study was to investigate if a standardized clinical diagnose of OSA, in ACS patients, increases the risk of cardiovascular events during hospitalization.
Patients and methods: In a prospective study involving 200 ACS patients, we tested if the identification of the risk of OSA by Berlin Questionnaire (BQ) would be capable of stratifying a subgroup of patients prone to higher frequency of cardiovascular events. The primary endpoint was a composite of cardiovascular death, stroke, recurrent cardiac ischemic events and acute pulmonary edema occurring during hospitalization. Groups were compared with the 2-tailed T student and Chi-square test or Fisher exact test. Logistic regression modeled the association of OSA and composite endpoints after adjustment for relevant covariates.
Results: Of 200 patients, 94 (47%) were likely to have OSA by BQ. Comparing patients with suspected OSA and patients with unsuspected OSA, we observed that both groups had similar age, gender, and rates of diabetes, dislipidemic and smoke habits. Nevertheless, OSA patients presented higher frequency of hypertension (92.5% vs 59.4%; p<0.01), obesity (40.4% vs 15.1%; p<0.01) and a trend to have lower ejection fraction (54.7% ± 13.7 vs 58.2% ± 13.1, p=0.09). In addition, OSA patients exhibited a higher incidence of cardiovascular events during hospitalization (18.1% vs 6.6%; p=0.02). In the logistic regression model, multivariate predictors of composite CV events were age (OR= 1.048; 95% CI 1.008 to 1.090; p=0.02), left ventricular ejection fraction (OR= 0.954; 95% CI 0.920 to 0.989; p=0.01), and a high risk of OSA evaluated by Berlin Questionnaire (OR= 3.657; 95% CI 1.216 to 10.996; p=0.02).
Conclusions: In the setting of ACS, the prevalence of OSA by BQ was very high (47%). Moreover, the odd of acute cardiovascular events during hospitalization was higher in OSA patients. The use of a simple and validated questionnaire (BQ) to stratify patients with suspected OSA may help in the prediction of cardiovascular events during hospitalization.