Spontaneous improvement of Sleep Apnea in Acute Coronary Syndromes

Sleep disorders such as Obstructive Sleep Apnea (OSA) lead to oxygen desaturation, sleep fragmentation and tissue suffering • OSA is a major cardiovascular risk like hypertension, diabetes and obesity • Therapy with CPAP do not prevent cardiovascular events in patients with moderate-to-severe obstructive sleep apnea and established cardiovascular disease • To date, the effect on clinical outcomes in Acute Coronary Syndrome (ACS) is debatable METHODS • We prospectively analyzed patients with ACS admitted to Policlinico Gemelli Cardiac Coronary Unit (CCU) from May 2019 to September 2019 (NCT04002739) • Patients performed a sleep study within 72 hours since admittance and at 3-month. Also, we performed Echocardiography, Coronary angiography, 24h-ECG monitoring, measurements of the levels and peaks of biomarkers for cardiac injury, nt-proBNP atrial peptide peak and percentage of extracellular water (ECW) assessed by bioelectrical impedance analysis. • At 3-month, patients did not have any intercurrent treatment for sleep apneas such as CPAP. • SAS software (9.4) was used to analyze the data and changes were assessed using a paired t-test The mean features of STEMI and NSTEMI patients were: Age 64.8 63.5 BMI (Kg/m2) 25.9 27.2 AHI (events/h) 37.5 30.7 ODI (events/h) 32.0 27.1 Nt-proBNP peak (ng/L) 1555 1455 LVEF (%) 49.8 54.5 The 3-month analysis did show a remarkable, spontaneous improvement of sleep disorder (ΔAHI: -12.5±2.9; CI 6.5-18.5; p=0.0002). Suggestions: 1. The impact of sleep disorders in Acute Coronary Syndromes is, still, questionable 2. We report on a significant, spontaneous change in sleep apnea syndrome in ACS at 3-month 3. OSA severity is associated with myocardial infarction extension and the 3-month AHI reduction was greater in the STEMI group compared to the NSTEMI one 4. The results could explain the debatable effect on clinical outcomes in ACS using CPAP in moderate-to-severe OSA disorder