Abstract
Objective: Obstructive sleep apnea (OSA) is an increasing yet under-recognized risk factor for acute coronary syndrome (ACS). We sought to determine the effects of ethnicity on the prevalence of OSA in patients presenting with ACS who participated in an overnight sleep study. Methods: A pooled analysis using patient-level data from the ISAACC Trial and Sleep and Stent Study was performed. In both of these studies, patients presenting with ACS were recruited to undergo an overnight sleep study. OSA was defined as an apnea-hypopnea index (AHI) of ≥15. A bivariate analysis of the factors affecting AHI and an age-adjusted analysis of the effect of BMI on sleep apnea according to ethnicity were conducted. Results: A total of 1961 patients were analyzed, including Spanish (53.6%, n=1050), Chinese (25.5%, n=500), Indian (12.0%, n=235), Malay (6.1%, n=119), Brazilian (1.7%, n=34) and Burmese (1.2%, n=23) populations. Significant differences in body mass index (BMI) were found among the various ethnic groups, averaging from 25.3 kg/m2 for Indians and 25.4 kg/m2 for Chinese to 28.6 kg/m2 for Spaniards. The prevalence of OSA was highest in the Spanish (63.1%), followed by the Chinese (50.2%), Malay (47.9%), Burmese (43.5%), Brazilian (41.2%), and Indian patients. Figure 1 shows the forest plot of the prevalence of OSA among the various ethnicities. A significant interaction between BMI and ethnicity to predict OSA was observed. The estimated odds ratio of BMI on OSA was highest in the Chinese population (1.17; 95% confidence interval: 1.10-1.24), but was not significant in the Spanish, Burmese or Brazilian populations. The area under the curve for the Asian patients (ranging from 0.6365 to 0.6692) was higher than that for the Spanish patients (0.5161). Conclusion: There was significant ethnic variation in the prevalence of OSA in patients with ACS, and the magnitude of the effect of BMI on OSA was greater in the Chinese population than in the Spanish patients.
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