International Journal of Cardiovascular Sciences. 15/May/2025;38:e20250032.

Short Editorial

Obstructive Sleep Apnea in Acute Myocardial Infarction: A Prognostic Risk Factor beyond Traditional Players?

DOI: 10.36660/ijcs.20250032

This Editorial is referred by the Research article "Associated Factors to the Risk of Obstructive Sleep Apnea in the Acute Phase of Myocardial Infarction".

The high prevalence of obstructive sleep apnea (OSA) and its worrisome association with various cardiovascular diseases, particularly ischemic heart disease, demand our attention. This common sleep disordered breathing, characterized by partial or complete upper airway obstructions during sleep, profoundly impacts overall health.^, In the cardiovascular context, intermittent hypoxia, sleep fragmentation, and intrathoracic pressure swings promoted by repeated respiratory events during sleep promote several potentially deleterious phenomena, including increased sympathetic activity, blood pressure fluctuations, chronic systemic inflammation, reactive oxygen species production, and endothelial dysfunction.^– These factors create a fertile ground for the development and progression of atherosclerosis,^, significantly increasing the likelihood of ischemic events if the condition remains undetected and untreated.^, However, the relationship between OSA and acute myocardial infarction (AMI) is complex. Patients with OSA often share risk factors that also increase AMI risk, notably age, male sex, and obesity. While some evidence suggests an independent role for OSA in the cardiovascular risk, its contribution remains controversial in high-risk patients with multiple comorbidities. Further research in this area is therefore warranted in order to provide additional insights.

In this issue of the International Journal of Cardiovascular Sciences, Carrijo et al. explore the complex relationship between OSA and traditional risk factors in 145 patients with ST-segment elevation myocardial infarction (STEMI). The authors used employed the widely used STOP-BANG questionnaire to assess OSA risk. The initial results were consistent with previous literature: a high frequency (58.6%) of patients exhibited a high risk for OSA. This highlights the urgent need for increased attention to this comorbidity, particularly in this specific patient population. In the multivariate analysis, the authors found an independent association of OSA with both male sex and hypertension in these patients. The presence of hypertension in OSA patients is not coincidental. Some of the aforementioned mechanisms associated with OSA directly contribute to elevated blood pressure, thereby increasing cardiovascular risk.^,