Abstract Body (Do not enter title and authors here): Introduction
Increasing evidence shows that obstructive sleep apnea (OSA) is a significant risk factor for cardiovascular disease. OSA may exacerbate recovery from ST-elevation myocardial infarction (STEMI), as chronic hypoxemia and hypercapnia has been shown to be associated with sympathetic hyperactivity, inflammatory response, endothelial dysfunction, and hypercoagulability. Acute outcomes of STEMI patients who have a diagnosis of OSA has not been well-studied.

Research Question
Does OSA affect inpatient outcomes in patients with a primary diagnosis of STEMI?

Methods
We conducted a retrospective analysis using the National Inpatient Sample database from 2016-2021 to examine the inpatient outcomes of STEMI patients in OSA patients compared to patients without OSA. Inclusion criteria encompassed patients diagnosed with acute STEMI and OSA based on ICD-10 codes.

Results
A total of 1,203,915 STEMI patients were identified; among these, 1,128,880 (93.7%) did not have a diagnosis of OSA, while 75,035 (6.3%) had a known diagnosis of OSA. Patients with OSA had lower in-hospital mortality (aOR=0.86, CI 0.80-0.90, p<0.001) compared to those without OSA but had higher rates of AKI (aOR 1.1), VTE (aOR 1.1), atrial fibrillation (aOR 1.4), atrial flutter (aOR 1.3), and non-invasive mechanical ventilation (aOR 3.1). Women with OSA, compared to men with OSA, were more likely to die in the hospital (aOR=1.17, CI 1.14-1.20, p<0.001) and had higher rates of VTE (aOR 1.2), but were less likely to undergo PCI, CABG, or have an intra-aortic balloon pump or Impella placed. Despite their higher mortality rate, women with OSA were less likely than men with OSA to develop inpatient complications such as sudden cardiac arrest, AKI, ventricular fibrillation, or ventricular tachycardia.

Conclusion
STEMI patients with a diagnosis of OSA had lower inpatient mortality rates compared to those without OSA, necessitating further investigation to understand this correlation. However, significant gender disparities were observed; women with OSA had higher mortality rates and underwent fewer interventions than men with OSA. Recognizing and addressing these trends is crucial for developing targeted interventions to mitigate these disparities.