Sleep study guided multidisciplinary therapy for acute coronary syndrome: a randomized trial

Background: Obstructive sleep apnea (OSA) is an emerging risk marker for acute coronary syndrome (ACS). This randomized trial determined the effects of Sleep Study Guided Multidisciplinary Therapy (SGMT) in patients with ACS. Methods: Among the 193 patients recruited, 96 were randomized to the SGMT and 97 to the Standard Therapy (control) groups. SGMT comprised sleep study during index admission and, for those with at least mild OSA, continuous positive airway pressure (CPAP) and behavioral therapy. Primary end point was change in plasma NT-pro BNP level between baseline and 7 months. Other biomarker endpoints included suppression of tumorigenicity 2 (ST2) and hs-CRP. Results: 159 (82%) patients completed the trial. Among the 70 patients in the SGMT group, mild (apnea-hypopnea index 5-15 per hour), moderate (>15-30) and severe (>30) OSA were diagnosed in 30%, 22% and 39% of the patients. In addition to behavioral therapy. CPAP was prescribed to 90% and positional pillow to 10% of the OSA patients. The overall CPAP adherence was 3.8±2.6 hrs per night. None of the 89 patients in the Standard Therapy (control) group underwent OSA screening or treatment. Cardiovascular medications, body mass index, blood pressure, and lipid profile were similar between the 2 groups during the course of the trial. The results are shown in Figure 1. Conclusion: In patients treated with guideline-mandated therapy for ACS, screening and treatment of OSA did not result in further lowering of cardiovascular risk.