Central sleep apnea after acute coronary syndrome and association with ticagrelor use

Study objectives: By modifying the apneic threshold, the antiplatelet agent ticagrelor could promote central sleep apnea hypopnea syndrome (CSAHS). We aimed to assess the association between CSAHS and ticagrelor administration. Methods: Patients were prospectively included within 1 year after acute coronary syndrome (ACS), if they had no heart failure (and left ventricular ejection fraction >= 45%) and no history of sleep apnea. After an overnight sleep study, patients were classified as normal with apnea hypopnea index (AHI) < 15, CSAHS patients with AHI >= 15 mostly with central sleep apneas, and obstructive sleep apnea hypopnea syndrome (OSAHS) patients with AHI >= 15 mostly with obstructive sleep apneas. Results: We included 121 consecutive patients (mean age 56.8 +/- 10.8, 88% men, mean body mass index 28.3 +/- 4.4 kg/m(2), left ventricular ejection fraction 56 +/- 5%, at a mean of 67 +/- 60 days (median 40 days, interquartile range: 30-80 days) after ACS. In total, 49 (45.3%) patients had AHI >= 15 (27 [22.3%] CSAHS %, 22 [18.2%] OSAHS). For 80 patients receiving ticagrelor, 24 (30%) had CSAHS with AHI >= 15, and for 41 patients not taking ticagrelor, only 3 (7.3%) had CSAHS with AHI >= 15 (chi-square = 8, p = 0.004). On multivariable analysis only age and ticagrelor administration were associated with the occurrence of CSAHS, (p = 0.0007 and p = 0.0006). Conclusion: CSA prevalence after ACS is high and seems promoted by ticagrelor administration. Results from monocentric study suggest a preliminary signal of safety. (C) 2021 Elsevier B.V. All rights reserved.

Automated summary

This study found that ticagrelor administration may promote the occurrence of central sleep apnea hypopnea syndrome (CSAHS) in patients after acute coronary syndrome (ACS), with high prevalence of CSAHS post-ACS. The results suggest a potential association between ticagrelor use and CSAHS, warranting further investigation for safety concerns.