Advertisement

Impact of Obstructive Sleep Apnea on Clinical and Angiographic Outcomes Following Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome

Published:November 08, 2006DOI:https://doi.org/10.1016/j.amjcard.2006.07.055
      There has been growing evidence associating obstructive sleep apnea (OSA) with cardiovascular pathogenesis. We hypothesized that OSA may affect outcomes after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). We performed a sleep study in 89 consecutive patients with ACS who were successfully treated with PCI. Patients with an apnea hypopnea index ≥10/hour were considered to have OSA. Co-morbidity of OSA with ACS was found in 51 patients (57%). There were no differences in baseline demographics between patients with and without OSA, except for significantly higher high-sensitivity C-reactive protein levels (0.59 ± 0.75 vs 0.29 ± 0.20 mg/dl, p = 0.019) in patients with OSA. Patients were followed for a mean period of 227 days. The incidence of major adverse cardiac events (cardiac death, reinfarction, and target vessel revascularization) was significantly higher in patients with OSA (23.5% vs 5.3%, p = 0.022). By multivariate analysis, the presence of OSA was an independent predictor for major adverse cardiac events (hazard ratio 11.61, 95% confidence interval 2.17 to 62.24, p = 0.004). In addition, quantitative coronary angiography at 6-month follow-up depicted significantly greater late loss (1.28 ± 0.84 vs 0.69 ± 0.81 mm, p = 0.003) and a higher binary restenosis rate (36.5% vs 15.4%, p = 0.026) in patients with OSA compared with those without OSA. In conclusion, the present study showed a high prevalence of OSA among patients with ACS. Moreover, OSA appeared to be an independent predictor for clinical and angiographic outcomes after PCI.
      To read this article in full you will need to make a payment

      References

        • Hung J.
        • Whitford E.G.
        • Parsons R.W.
        • Hillman D.R.
        Association of sleep apnoea with myocardial infarction in men.
        Lancet. 1990; 336: 261-264
        • Young T.
        • Palta M.
        • Dempsey J.
        • Skatrud J.
        • Weber S.
        • Badr S.
        The occurrence of sleep-disordered breathing among middle-aged adults.
        N Engl J Med. 1993; 328: 1230-1235
        • Mooe T.
        • Rabben T.
        • Wiklund U.
        • Franklin K.A.
        • Eriksson P.
        Sleep-disordered breathing in men with coronary artery disease.
        Chest. 1996; 109: 659-663
        • Schafer H.
        • Koehler U.
        • Ewig S.
        • Hasper E.
        • Tasci S.
        • Luderitz B.
        Obstructive sleep apnea as a risk marker in coronary artery disease.
        Cardiology. 1999; 92: 79-84
        • Peker Y.
        • Kraiczi H.
        • Hedner J.
        • Loth S.
        • Johansson A.
        • Bende M.
        An independent association between obstructive sleep apnoea and coronary artery disease.
        Eur Respir J. 1999; 14: 179-184
        • Leung R.S.
        • Bradley T.D.
        Sleep apnea and cardiovascular disease.
        Am J Respir Crit Care Med. 2001; 164: 2147-2165
        • Meoli A.L.
        • Casey K.R.
        • Clark R.W.
        • Coleman Jr, J.A.
        • Fayle R.W.
        • Troell R.J.
        • Iber C.
        Hypopnea in sleep-disordered breathing in adults.
        Sleep. 2001; 24: 469-470
        • Mooe T.
        • Franklin K.A.
        • Holmstrom K.
        • Rabben T.
        • Wiklund U.
        Sleep-disordered breathing and coronary artery disease: long-term prognosis.
        Am J Respir Crit Care Med. 2001; 164: 1910-1913
        • Peker Y.
        • Hedner J.
        • Kraiczi H.
        • Loth S.
        Respiratory disturbance index: an independent predictor of mortality in coronary artery disease.
        Am J Respir Crit Care Med. 2000; 162: 81-86
        • Johns M.W.
        A new method for measuring daytime sleepiness: the Epworth sleepiness scale.
        Sleep. 1991; 14: 540-545
        • Somers V.K.
        • Dyken M.E.
        • Clary M.P.
        • Abboud F.M.
        Sympathetic neural mechanisms in obstructive sleep apnea.
        J Clin Invest. 1995; 96: 1897-1904
        • Stoohs R.
        • Guilleminault C.
        Cardiovascular changes associated with obstructive sleep apnea syndrome.
        J Appl Physiol. 1992; 72: 583-589
        • Hanly P.
        • Sasson Z.
        • Zuberi N.
        • Lunn K.
        ST-segment depression during sleep in obstructive sleep apnea.
        Am J Cardiol. 1993; 71: 1341-1345
        • Lemos P.A.
        • Mercado N.
        • van Domburg R.T.
        • Kuntz R.E.
        • O’Neill W.W.
        • Serruys P.W.
        Comparison of late luminal loss response pattern after sirolimus-eluting stent implantation or conventional stenting.
        Circulation. 2004; 110: 3199-3205
        • Stone G.W.
        • Brodie B.R.
        • Griffin J.J.
        • Costantini C.
        • Morice M.C.
        • St Goar F.G.
        • Overlie P.A.
        • Popma J.J.
        • McDonnell J.
        • Jones D.
        • et al.
        Clinical and angiographic follow-up after primary stenting in acute myocardial infarction: the Primary Angioplasty in Myocardial Infarction (PAMI) stent pilot trial.
        Circulation. 1999; 99: 1548-1554
        • Hoffmann R.
        • Mintz G.S.
        • Dussaillant G.R.
        • Popma J.J.
        • Pichard A.D.
        • Satler L.F.
        • Kent K.M.
        • Griffin J.
        • Leon M.B.
        Patterns and mechanisms of in-stent restenosis.
        Circulation. 1996; 94: 1247-1254
        • Shamsuzzaman A.S.
        • Winnicki M.
        • Lanfranchi P.
        • Wolk R.
        • Kara T.
        • Accurso V.
        • Somers V.K.
        Elevated C-reactive protein in patients with obstructive sleep apnea.
        Circulation. 2002; 105: 2462-2464
        • Buffon A.
        • Liuzzo G.
        • Biasucci L.M.
        • Pasqualetti P.
        • Ramazzotti V.
        • Rebuzzi A.G.
        • Crea F.
        • Maseri A.
        Preprocedural serum levels of C-reactive protein predict early complications and late restenosis after coronary angioplasty.
        J Am Coll Cardiol. 1999; 34: 1512-1521
        • Heeschen C.
        • Hamm C.W.
        • Bruemmer J.
        • Simoons M.L.
        • CAPTURE Investigators
        Predictive value of C-reactive protein and troponin T in patients with unstable angina: a comparative analysis.
        J Am Coll Cardiol. 2000; 35 (Chimeric c7E3 AntiPlatelet Therapy in Unstable angina REfractory to standard treatment trial): 1535-1542
        • Schulz R.
        • Mahmoudi S.
        • Hattar K.
        • Sibelius U.
        • Olschewski H.
        • Mayer K.
        • Seeger W.
        • Grimminger F.
        Enhanced release of superoxide from polymorphonuclear neutrophils in obstructive sleep apnea.
        Am J Respir Crit Care Med. 2000; 162: 566-570
        • Dyugovskaya L.
        • Lavie P.
        • Lavie L.
        Increased adhesion molecules expression and production of reactive oxygen species in leukocytes of sleep apnea patients.
        Am J Respir Crit Care Med. 2002; 165: 934-939
        • Yokoe T.
        • Minoguchi K.
        • Matsuo H.
        • Oda N.
        • Minoguchi H.
        • Yoshino G.
        • Hirano T.
        • Adachi M.
        Elevated levels of C-reactive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure.
        Circulation. 2003; 107: 1129-1134
        • Ohga E.
        • Nagase T.
        • Tomita T.
        • Teramoto S.
        • Matsuse T.
        • Katayama H.
        • Ouchi Y.
        Increased levels of circulating ICAM-1, VCAM-1, and L-selectin in obstructive sleep apnea syndrome.
        J Appl Physiol. 1999; 87: 10-14