Clinical significance of obstructive sleep apnea in patients with acute coronary syndrome with or without prior stroke: a prospective cohort study

Additive Effect of Multilevel Radiofrequency Ablation in Elderly Patients with Sleep Apnea

Elderly patients with Obstructive sleep apnea (OSA) often struggle with positive airway therapy due to low adherence. This study explores Radiofrequency ablation (RFA) as a treatment alongside weight loss and tongue-retaining device for OSA in older adults. Through a randomized trial, we compare RFA effectiveness to a control group, aiming to establish its potential role in managing OSA in this vulnerable population. The control group received only weight loss and tongue-retaining device recommendations. In the intervention group, these measures were supplemented with RFA of the soft palate and inferior turbinates. After three months, both groups were assessed for changes in sleep study parameters, BMI, and tongue-retaining device adherence. Twenty patients in the control group and 23 in the intervention group completed the trial. The average age was 60.25 years old (SD = 5.88) in the control group and 61.83 years old (SD = 5.21) in the RFA group. Both groups experienced significant BMI reductions, with the control group averaging a decrease of 1.5 kg/m² (SD = 2.4 kg/m²) and the RFA group averaging a decrease of 1.3 kg/m² (SD = 1.1 kg/m²). Tongue-retaining device adherence was 50% in the control group and 56.5% in the RFA group. The RFA group achieved a significantly greater proportionate reduction in AHI compared to the control group (p = 0.04, effect size=-0.38). This randomized controlled trial showed that RFA on the soft palate and inferior turbinate is a well-tolerated and potentially effective treatment option for elderly patients with OSA. Further research with larger samples and longer follow-ups is needed to confirm these findings and assess long-term durability.

The Long-Term Prognostic Role of Nighttime Resting Heart Rate in Obstructive Sleep Apnea in Patients with Acute Coronary Syndrome

AIM

A close relationship exists between resting heart rate (RHR) and obstructive sleep apnea (OSA). Still, the prognostic importance of nighttime RHR in patients with acute coronary syndrome (ACS) with or without OSA remains unclear.

METHODS

In this prospective cohort study, OSA was defined as an apnea-hypopnea index of ≥ 15 events/h, and the high nighttime RHR (HNRHR) was defined as a heart rate of ≥ 70 bpm. The primary endpoint was a major adverse cardiovascular and cerebrovascular event (MACCE), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for heart failure.

RESULTS

Among the 1875 enrolled patients, the mean patient age was 56.3±10.5 years, 978 (52.2%) had OSA, and 425 (22.7%) were in HNRHR. The proportion of patients with HNRHR is higher in the OSA population than in the non-OSA population (26.5% vs. 18.5%; P＜0.001). During 2.9 (1.5, 3.5) years of follow-up, HNRHR was associated with an increased risk of MACCE in patients with OSA (adjusted HR: 1.56, 95% CI: 1.09-2.23, P=0.014), but not in patients without OSA (adjust HR: 1.13, 95% CI: 0.69-1.84, P=0.63).

CONCLUSIONS

In patients with ACS, a nighttime RHR of ≥ 70 bpm was associated with a higher risk of MACCE in those with OSA but not in those without it. This identifies a potential high-risk subgroup where heart rate may interact with the prognosis of OSA. Further research is needed to determine causative relationships and confirm whether heart rate control impacts cardiovascular outcomes in patients with ACS-OSA.

Neck circumference as an additional predictor of cardiovascular disease mortality: A multi-center prospective population-based study in northeastern China

BACKGROUND AND AIMS

This study aimed to assess the potential of neck circumference (NC) and neck-to-height ratio (NHR) as predictors of future cardiovascular disease (CVD) mortality in a general population from Northeastern China.

METHODS

A multi-center prospective study was conducted in Northeastern China, involving 18, 796 participants. The associations between NC or NHR and the incidence of overall CVD mortality, stroke mortality, and coronary heart disease (CHD) mortality were examined using multivariate Cox regression models. Hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) were calculated. Reclassification analyses were conducted to determine the incremental predictive value of NC or NHR.

RESULTS

NC was significantly associated with the risk of CVD mortality, independent of other anthropometric measurements for obesity. Individuals in the highest quartile of NC had a 1.83-fold (95% CI 1.29 to 2.61) and a 2.40-fold (95% CI 1.45 to 4.00) higher risk of overall CVD mortality and CHD mortality, respectively. Larger NC was significantly related to a heightened risk of ischemic stroke mortality, although no such association was observed with hemorrhagic stroke mortality. Furthermore, the risk of overall CVD mortality, stroke mortality, and CHD mortality increased by approximately 1.21 to 1.25 times per 1-SD change in NC. Similar findings were observed for NHR. The percentages of correct classification of overall CVD mortality improved by 12.1% and 16.3% after the addition of NC or NHR into established models, respectively.

CONCLUSIONS

NC and NHR might be promising predictors of CVD mortality, with higher values indicating greater risk.