1002 The Hemodynamic-Electrical Divergence: Analysis of the Sleep Apnea Paradox and Incidence of Arrhythmias in Percutaneous Coronary Intervention

Abstract Introduction Obstructive Sleep Apnea (OSA) has been associated with increased long-term cardiovascular risk; however, its impact on short-term outcomes during hospitalization for percutaneous coronary intervention (PCI) is unclear. We utilized a large national database to determine the impact of obstructive sleep apnea on inpatient outcomes in patients undergoing PCI. Methods We performed a retrospective analysis of the U.S. National Inpatient Sample (NIS) for the years 2016–2019. All adult hospitalizations with PCI were identified by ICD procedural codes and grouped by a diagnosis code for OSA. Baseline characteristics were compared between the OSA and non-OSA groups. The primary outcome was in-hospital all-cause mortality. Secondary outcomes included major complications, length of stay (LOS), and total hospital charges. We used survey-weighted logistic regression to compute adjusted odds ratios (ORs) for binary outcomes and linear regression on log-transformed LOS and charges, controlling for baseline characteristics and hospital factors. Kaplan-Meier survival analysis was also performed. Results We identified 318,220 weighted hospitalizations with PCI, of which 37,815(11.9%) had a diagnosis of OSA. The OSA group had higher prevalences of obesity, diabetes, hypertension, heart failure, and chronic lung disease. Despite having more cardiovascular risk factors, the OSA group had lower unadjusted in-hospital mortality (3.3% vs. 5.6%, p 0.001). The unadjusted rates of new arrhythmia (32.1% vs. 27.1%, p 0.001), in-hospital MI (34.5% vs. 26.5%, p 0.001), and cardiogenic shock (7.0% vs. 10.0%, p 0.001) also differed between groups. In multivariable analysis, In contrast, OSA was associated with higher adjusted odds of developing an arrhythmia (OR 1.20, 95% CI 1.14–1.27; p 0.001) and lower odds of in-hospital MI (OR 0.71, 95% CI 0.67–0.75; p 0.001) and cardiogenic shock (OR 0.70, 95% CI 0.63–0.77; p 0.001). Patients with OSA also had modestly longer hospitalizations and lower total charges and higher in-hospital survival (log-rank p 0.001) Conclusion In patients undergoing PCI, obstructive sleep apnea is associated with a "survival paradox" characterized by reduced mortality and hemodynamic collapse, potentially attributable to ischemic preconditioning or ascertainment bias. However, this survival advantage is accompanied by increased electrical instability. Clinicians should prioritize arrhythmia monitoring in this population while recognizing their distinct hemodynamic resilience. Support (if any)