Respiratory Polygraphy Patterns and Risk of Recurrent Cardiovascular Events in Patients With Acute Coronary Syndrome

Andrea Zapater; Geoffroy Solelhac; Alicia Sánchez-de-la-Torre; Esther Gracia-Lavedan; Ivan David Benitez; Gerard Torres; Jordi De Batlle; José Haba-Rubio; Mathieu Berger; Jorge Abad; Joaquín Duran-Cantolla; Amaia Urrutia; Olga Mediano; María José Masdeu; Estrella Ordax-Carbajo; Juan Fernando Masa; Mónica De la Peña; Mercé Mayos; Ramon Coloma; Josep María Montserrat; Eusebi Chiner; Olga Mínguez; Lydia Pascual; Anunciación Cortijo; Dolores Martínez; Mireia Dalmases; Chi-Hang Lee; R Doug McEvoy; Ferran Barbé; Raphael Heinzer; Manuel Sánchez-de-la-Torre; Spanish Sleep Network

doi:10.3389/fmed.2022.870906

Respiratory Polygraphy Patterns and Risk of Recurrent Cardiovascular Events in Patients With Acute Coronary Syndrome

Front Med (Lausanne). 2022 Jun 27:9:870906. doi: 10.3389/fmed.2022.870906. eCollection 2022.

Authors

Andrea Zapater^{1

2}, Geoffroy Solelhac³, Alicia Sánchez-de-la-Torre^{2

4}, Esther Gracia-Lavedan^{2

4}, Ivan David Benitez^{2

4}, Gerard Torres^{2

4}, Jordi De Batlle^{2

4}, José Haba-Rubio³, Mathieu Berger³, Jorge Abad^{2

5}, Joaquín Duran-Cantolla^{2

6}, Amaia Urrutia⁷, Olga Mediano^{2

8}, María José Masdeu^{2

9}, Estrella Ordax-Carbajo¹⁰, Juan Fernando Masa^{2

11}, Mónica De la Peña¹², Mercé Mayos^{2

13}, Ramon Coloma¹⁴, Josep María Montserrat^{2

15}, Eusebi Chiner¹⁶, Olga Mínguez⁴, Lydia Pascual⁴, Anunciación Cortijo⁴, Dolores Martínez⁴, Mireia Dalmases^{2

4}, Chi-Hang Lee¹⁷, R Doug McEvoy¹⁸, Ferran Barbé^{2

3}, Raphael Heinzer^{3

19}, Manuel Sánchez-de-la-Torre^{1

2}; Spanish Sleep Network

Collaborators

Spanish Sleep Network:
Laura Abad, Aida Munϸoz, Elisabet Zamora, Ignacio Vicente, Sandra Ingleìs, Carlos Egea, Jaime Marcos, Almudena Fernaìndez, Valentin Cabriada-Nuño, Sonia Castro, Leyre Serrano, Marina Floreìs, Anna Mas, Maricel Arboneìs, Silvia Ortega, Alicia Martiìn, Jose Miguel Romaìn-Saìnchez, Ma Isabel Valiente-Diaz, Ma Esther Viejo-Ayuso, Concepcioìn Rodriìguez-Garciìa, Laura Vigil, Enriqueta Ramiìrez, Mariìa Pinϸar, Elisabet Martiìnez, Blanca Barriuso, Jaime Corral, Francisco Javier Goìmez de Terreros Caro, Antonia Barceloì, Paloma Gimeìnez, Ana Ma Fortuna, Patricia Penñacoba, Abel Jesuìs Martiìnez-Garciìa, Sergio Garciìa-Castillo, Lara Navas, Onintza Garmendia, Joseì Sancho, Salvador Perelloì, Gemma Rubinoìs, Rocío Gallego

Affiliations

¹ Precision Medicine in Chronic Diseases, Hospital Universitari Arnau de Vilanova-Santa Maria, IRB Lleida, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.
² Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
³ Center for Investigation and Research in Sleep, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁴ Translation Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain.
⁵ Respiratory Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.
⁶ Servicio de Investigación OSI, IIS Bioaraba, Hospital Universitario Araba, Vitoria-Gasteiz, Spain.
⁷ Servicio Neumologia, Hospital Universitario Cruces, Bizkaia, Spain.
⁸ Respiratory Department, Hospital Universitario de Guadalajara, Guadalajara, Spain.
⁹ Respiratory and Sleep Department, Hospital Universitari Parc Taulí, Institut Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona, Barcelona, Spain.
¹⁰ Respiratory Department, Hospital Universitario de Burgos, Burgos, Spain.
¹¹ Respiratory Department, Hospital San Pedro Alcántara, Cáceres, Spain.
¹² Clinic Analysis and Respiratory Services, Institut de Investigació Sanitaria de Palma, Hospital Universitari Son Espases, Palma de Mallorca, Spain.
¹³ Sleep Unit, Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
¹⁴ Respiratory Department, Hospital General Universitario de Albacete, Albacete, Spain.
¹⁵ Respiratory Department, Hospital Clinic, Barcelona, Spain.
¹⁶ Respiratory Department, Hospital Universitari Sant Joan d'Alacant, Alicante, Spain.
¹⁷ Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore.
¹⁸ Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
¹⁹ Pulmonary Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

Abstract

Introduction: Obstructive sleep apnea (OSA) severity is based on the apnea-hypopnea index (AHI). The AHI is a simplistic measure that is inadequate for capturing disease severity and its consequences in cardiovascular diseases (CVDs). Deleterious effects of OSA have been suggested to influence the prognosis of specific endotypes of patients with acute coronary syndrome (ACS). We aim to identify respiratory polygraphy (RP) patterns that contribute to identifying the risk of recurrent cardiovascular events in patients with ACS.

Methods: Post hoc analysis of the ISAACC study, including 723 patients admitted for a first ACS (NCT01335087) in which RP was performed. To identify specific RP patterns, a principal component analysis (PCA) was performed using six RP parameters: AHI, oxygen desaturation index, mean and minimum oxygen saturation (SaO₂), average duration of events and percentage of time with SaO₂ < 90%. An independent HypnoLaus population-based cohort was used to validate the RP components.

Results: From the ISAACC study, PCA showed that two RP components accounted for 70% of the variance in the RP data. These components were validated in the HypnoLaus cohort, with two similar RP components that explained 71.3% of the variance in the RP data. The first component (component 1) was mainly characterized by low mean SaO₂ and obstructive respiratory events with severe desaturation, and the second component (component 2) was characterized by high mean SaO₂ and long-duration obstructive respiratory events without severe desaturation. In the ISAACC cohort, component 2 was associated with an increased risk of recurrent cardiovascular events in the third tertile with an adjusted hazard ratio (95% CI) of 2.44 (1.07 to 5.56; p-value = 0.03) compared to first tertile. For component 1, no significant association was found for the risk of recurrent cardiovascular events.

Conclusion: A RP component, mainly characterized by intermittent hypoxemia, is associated with a high risk of recurrent cardiovascular events in patients without previous CVD who have suffered a first ACS.

Keywords: acute coronary syndrome; cardiovascular disease; obstructive sleep apnea; precision medicine; respiratory polygraphy.

Copyright © 2022 Zapater, Solelhac, Sánchez-de-la-Torre, Gracia-Lavedan, Benitez, Torres, De Batlle, Haba-Rubio, Berger, Abad, Duran-Cantolla, Urrutia, Mediano, Masdeu, Ordax-Carbajo, Masa, De la Peña, Mayos, Coloma, Montserrat, Chiner, Mínguez, Pascual, Cortijo, Martínez, Dalmases, Lee, McEvoy, Barbé, Heinzer and Sánchez-de-la-Torre.