Phenogroup-based stratification of cardiovascular risk in obstructive sleep apnea

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dc.contributor.authorKosasih, Anastasya Maria
dc.contributor.authorOu, Yihui
dc.contributor.authorKoo, Chieh-Yang
dc.contributor.authorDrager, Luciano F
dc.contributor.authorZhang, Junjie
dc.contributor.authorSethi, Rishi
dc.contributor.authorLi, Ruogu
dc.contributor.authorHo, Hee-Hwa
dc.contributor.authorLoo, Germaine
dc.contributor.authorOng, Thun-How
dc.contributor.authorSia, Ching-Hui
dc.contributor.authorChen, Zhengfeng
dc.contributor.authorSim, Hui-Wen
dc.contributor.authorKang, Giap-Swee
dc.contributor.authorSorokin, Vitaly
dc.contributor.authorWong, Serene
dc.contributor.authorChew, Nicholas
dc.contributor.authorChan, Mark Y
dc.contributor.authorRichards, Arthur Mark
dc.contributor.authorChen, Shao-Liang
dc.contributor.authorTan, Huay-Cheem
dc.contributor.authorBarbé Illa, Ferran
dc.contributor.authorTam, Wilson W
dc.contributor.authorLee, Chi-Hang
dc.date.accessioned2026-07-08T10:37:29Z
dc.date.available2026-07-08T10:37:29Z
dc.date.issued2026
dc.description.abstractBackground: Obstructive sleep apnea (OSA) exhibits substantial phenotypic heterogeneity, but its prognostic relevance in patients with coronary artery disease (CAD) undergoing revascularization remains uncertain. Methods: We pooled data from two prospective cohorts of CAD patients undergoing percutaneous coronary intervention or coronary artery bypass grafting (n = 2318). Major adverse cardiac and cerebrovascular events (MACCE; cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and unplanned revascularization) were assessed over a mean follow-up of 1.9 ± 1.1 years. Latent class analysis using nine clinical variables identified phenogroups. Associations between OSA (apnea-hypopnea index ≥15) and MACCE were evaluated using Cox regression. Results: Three phenogroups were identified: (1) Younger-Sleepy-Hypoxia (42.2%), (2) Cardiorenal-Metabolic (30.9%), and (3) Old-Lean-Chinese (26.9%). OSA prevalence was similar across groups (45.5%, 50.7%, and 47.8%). The overall incidence of MACCE was 11.4% and did not differ significantly across phenogroups (p = 0.127). OSA was associated with increased MACCE risk in the overall cohort (adjusted HR 1.55, 95% CI 1.20-2.00; p < 0.001). In phenogroup analyses, this association was significant in phenogroup 1 (adjusted HR 1.57, 95% CI 1.04-2.36; p = 0.030), borderline in phenogroup 2 (adjusted HR 1.55, 95% CI 0.98-2.43; p = 0.059), and not significant in phenogroup 3 (adjusted HR 1.32, 95% CI 0.81-2.16; p = 0.263). Conclusions: In revascularized CAD patients, OSA was associated with increased cardiovascular risk in the overall cohort, with heterogeneity across phenogroups. These findings support phenogroup-based risk stratification, pending external validation.
dc.identifier.doihttps://doi.org/10.1016/j.ajpc.2026.101681
dc.identifier.issn2666-6677
dc.identifier.urihttps://hdl.handle.net/10459.1/470825
dc.language.isoen
dc.publisherElsevier
dc.relation.isformatofReproducció del document publicat a: https://doi.org/10.1016/j.ajpc.2026.101681
dc.relation.ispartofAmerican Journal of Preventive Cardiology, 2026, vol. 28, 101681
dc.rightscc-by (c)The Authors, 2026
dc.rightsAttribution 4.0 International*
dc.rights.accessRightsinfo:eu-repo/semantics/openAccess
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/*
dc.subjectCoronary artery disease
dc.subjectPhenogroup
dc.subjectRisk prediction
dc.subjectSleep apnea
dc.titlePhenogroup-based stratification of cardiovascular risk in obstructive sleep apnea
dc.typeinfo:eu-repo/semantics/article
dc.type.versioninfo:eu-repo/semantics/publishedVersion
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