Abstract Body: Introduction:
Obstructive Sleep Apnea (OSA) is a known risk factor for cardiovascular diseases and has been linked to a higher incidence of non-ST segment elevation myocardial infarction (NSTEMI). However, the impact of OSA on in-hospital outcomes remains controversial. This study investigates the association of OSA with in-hospital mortality and clinical outcomes in NSTEMI patients, including gender-based differences.
Hypothesis:
We hypothesized that OSA would be associated with worse in-hospital outcomes among NSTEMI patients.
Methods:
This retrospective cohort study used Nationwide Inpatient Sample (NIS) data from 2016 to 2021, identifying 3,935,084 NSTEMI admissions. Multivariable logistic regression and propensity score matching (PSM) adjusted for demographics, comorbidities, and hospital characteristics. Gender-specific outcomes were analyzed using logistic regression. Primary outcomes included in-hospital mortality, with secondary outcomes covering cardiac arrest, cardiogenic shock, arrhythmias, mechanical and ventilatory support, healthcare utilization and cardiac procedures.
Results:
OSA patients had lower in-hospital mortality (aOR: 0.8; 95% CI: 0.7–0.8; p < 0.001) and reduced odds of sudden cardiac arrest, invasive ventilation, cardiogenic shock, and thrombolysis. However, they were more likely to require non-invasive ventilation (aOR: 2.2; 95% CI: 2.1–2.3; p < 0.001) and had higher odds of atrial fibrillation, atrial flutter, and pacemaker insertion.
Female NSTEMI patients with OSA showed lower in-hospital mortality (aOR: 0.9; 95% CI: 0.8–0.9; p < 0.001). However, they underwent fewer procedures, including PCI (aOR: 0.8), CABG (aOR: 0.6), and coronary angiography (aOR: 0.9; p < 0.001 for all). Females also had a higher risk of venous thromboembolism (aOR: 1.12; 95% CI: 1.1–1.2). Hospital costs were $6,460.93 lower for OSA patients, with females incurring $11,104.87 less than males. Length of stay differences were not statistically significant (p = 0.251).
Conclusions:
OSA is associated with improved in-hospital survival among NSTEMI patients despite the increased need for non-invasive ventilation and arrhythmias. The gender-specific analysis highlights disparities, as female patients had lower mortality but underwent fewer diagnostic and interventional procedures, raising concerns about potential under-treatment. These findings call for further investigation into the role of sex differences in guiding care for NSTEMI patients with OSA.