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DOI: 10.48087/BJMS.2026.130303
Authors: Sofiane GHEMRI, Adlane REZZOUG, Sihem ATOUB, Nachida BENMIRADI
Affiliations: Université des Sciences de la Santé El Moudjahid Dr Youcef El Khatib, Faculté de Médecine, Alger ; EHS Dr Maouche Mohand Amokrane, Alger, Algérie.
Abstract
Background: While Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) is a recognized cardiovascular risk factor, its impact on the anatomical extent of coronary lesions during acute coronary syndrome (ACS) remains debated. Chronic intermittent hypoxia may promote more diffuse atherosclerosis. Objective: This study aimed to determine whether the presence and severity of OSAHS are associated with increased clinical severity and multivessel coronary artery disease in patients admitted for a first episode of non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Methods: This prospective, single-center study included 241 consecutive patients admitted for an inaugural NSTE-ACS between September 2019 and September 2020. All patients underwent coronary angiography and OSAHS screening via type III respiratory polygraphy during hospitalization. Severe OSAHS was defined as an Apnea-Hypopnea Index (AHI) >30 events/h. Disease severity was assessed using the GRACE risk score, echocardiography, and the number of stenosed coronary vessels. Results: The overall prevalence of OSAHS (AHI >15) was 52.7%, with a large proportion of severe forms. Multivariate analysis demonstrated that severe OSAHS was associated with more diffuse anatomical disease. Specifically, compared to single-vessel disease, the presence of severe OSAHS significantly increased the risk of two-vessel disease (OR = 2.30; 95% CI: 1.07–4.98; p = 0.019) and showed a strong trend toward three-vessel disease (OR = 2.07; 95% CI: 0.93–4.63; p = 0.048). Clinically, this anatomical diffusion was accompanied by an increased severity profile, with severe OSAHS being strongly associated with a GRACE risk score >140 (OR = 2.27; 95% CI: 1.30–3.98; p = 0.002) and the presence of left ventricular wall motion abnormalities (OR = 2.72; p = 0.013). Conclusion: Among patients admitted for an inaugural NSTE-ACS, severe OSAHS goes beyond being a mere comorbidity to establish itself as an independent predictor of coronary artery disease extent. It is associated with more diffuse angiographic lesions (multivessel disease) and a higher clinical risk profile upon admission, which may directly impact the revascularization strategy.
Keywords: Severe OSAHS, NSTE-ACS, Coronary Angiography, Multivessel Disease, GRACE Score.