Abstract
Background: Obstructive sleep apnea (OSA) exhibits substantial phenotypic heterogeneity, but its prognostic relevance in patients with coronary artery disease (CAD) undergoing revascularization remains uncertain.
Methods: We pooled data from two prospective cohorts of CAD patients undergoing percutaneous coronary intervention or coronary artery bypass grafting (n = 2318). Major adverse cardiac and cerebrovascular events (MACCE; cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and unplanned revascularization) were assessed over a mean follow-up of 1.9 ± 1.1 years. Latent class analysis using nine clinical variables identified phenogroups. Associations between OSA (apnea–hypopnea index ≥15) and MACCE were evaluated using Cox regression.
Results: Three phenogroups were identified: (1) Younger-Sleepy-Hypoxia (42.2%), (2) Cardiorenal-Metabolic (30.9%), and (3) Old-Lean-Chinese (26.9%). OSA prevalence was similar across groups (45.5%, 50.7%, and 47.8%). The overall incidence of MACCE was 11.4% and did not differ significantly across phenogroups (p = 0.127). OSA was associated with increased MACCE risk in the overall cohort (adjusted HR 1.55, 95% CI 1.20–2.00; p < 0.001). In phenogroup analyses, this association was significant in phenogroup 1 (adjusted HR 1.57, 95% CI 1.04–2.36; p = 0.030), borderline in phenogroup 2 (adjusted HR 1.55, 95% CI 0.98–2.43; p = 0.059), and not significant in phenogroup 3 (adjusted HR 1.32, 95% CI 0.81–2.16; p = 0.263).
Conclusions: In revascularized CAD patients, OSA was associated with increased cardiovascular risk in the overall cohort, with heterogeneity across phenogroups. These findings support phenogroup-based risk stratification, pending external validation.