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Reshetnik A, Puppe S, Bonnemeier H. Central Sleep Apnoea and Arrhythmogenesis After Myocardial Infarction-The CESAAR Study. Front Cardiovasc Med 2019; 6:108. [PMID: 31448290 PMCID: PMC6691753 DOI: 10.3389/fcvm.2019.00108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/19/2019] [Indexed: 12/26/2022] Open
Abstract
The prevalence of sleep disordered breathing (SDB) after acute myocardial infarction (AMI) is high. However, little is known about predominant SDB type and the impact of SDB severity on arrhythmogenesis. We conducted a prospective single-center observational study and performed an unattended sleep study and Holter monitoring within 10 days after AMI, and an unattended sleep study 11.3 months after AMI. All patients were included from the Department of Cardiology at the University Hospital Schleswig-Holstein, Lübeck, Germany. A total of 202 subjects with AMI (73.8% with ST-elevation; 59.8 years; 73.8% male) were included. The mean BMI was 27.8 kg/m2 and the mean neck/waist circumference was 41.7/103.3 cm. The mean left ventricular ejection fraction was 56.6%. The SDB prevalence defined as apnoea-hypopnea-index (AHI) ≥ 5/h was 66.7% with 44.9% having central (CSA), and 21.8% obstructive sleep apnoea (OSA). The mean AHI was 13.8 1/h. In 10.2% nsVT was detected in the Holter monitoring. AI >23/h was independently associated with higher risk of nsVT in the subacute AMI period. SDB is highly prevalent and CSA a predominant type of SDB in the subacute phase after uncomplicated AMI treated with modern revascularization procedures and evidence-based pharmacological therapy. Severe SDB is independently associated with higher risk for nsVT in the subacute AMI period and its course should be monitored as it can potentially have a negative impact on relevant outcomes of AMI patients. Further prospective studies are needed to assess long-term follow up of SDB after AMI and its impact on mortality and morbidity.
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Affiliation(s)
- Alexander Reshetnik
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Nephrology, Berlin, Germany
| | - Swetlana Puppe
- Department of Psychiatry, Evangelisches Krankenhaus Königin Elisabeth Herzberge gGmbH, Berlin, Germany
| | - Hendrik Bonnemeier
- Department of Cardiology, Universitätsklinik Schleswig-Holstein, Kiel, Germany
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Madsen MT, Huang C, Zangger G, Zwisler ADO, Gögenur I. Sleep Disturbances in Patients With Coronary Heart Disease: A Systematic Review. J Clin Sleep Med 2019; 15:489-504. [PMID: 30853047 DOI: 10.5664/jcsm.7684] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 01/08/2019] [Indexed: 12/19/2022]
Abstract
STUDY OBJECTIVES Investigation into sleep and coronary heart disease (CHD) has predominantly been focused on sleep disturbances as a risk factor for developing CHD. Objectively measured and self-reported sleep at a patient level has only been sparsely and not systematically reported. Therefore, we set out to review the literature for studies using objectively measured and self-reported sleep in patients with CHD. The review focuses on patients with acute coronary syndrome (ACS) and stable CHD. METHODS A systematic review performed in four databases adhering to the PRISMA guidelines applying a qualitative synthesis of evidence. RESULTS Following ACS, we found sleep architecture to be significantly disturbed with changes normalizing over a period of up to 6 months. With increasing severity of CHD, sleep disturbances were more pronounced; however, the modulating effects of sleep-disordered breathing and ejection fraction on sleep in patients with CHD are conflicting. Overall, studies were predominantly cross-sectional in design and of low methodological quality. Polysomnography was the predominant outcome assessment tool and validated self-reported assessment tools were limited. CONCLUSIONS Future investigations in sleep and CHD applying both a longitudinal design and investigating objective and self-reported sleep assessments are warranted. SYSTEMATIC REVIEW REGISTRATION Registry: PROSPERO, Title: Sleep measures in relation to coronary heart disease: a systematic review, Identifier: CRD42017056377, URL: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=56377.
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Affiliation(s)
- Michael Tilling Madsen
- Center for Surgical Science, Zealand University Hospital, Denmark.,Department of Emergency, Zealand University Hospital, Denmark
| | - Chenxi Huang
- Center for Surgical Science, Zealand University Hospital, Denmark
| | - Graziella Zangger
- REHPA - Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Denmark
| | - Ann Dorthe Olsen Zwisler
- REHPA - Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Denmark
| | - Ismail Gögenur
- Center for Surgical Science, Zealand University Hospital, Denmark
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Lin MT, Lai CL, Lee PL, Shen MH, Yu CJ, Fang CT, Chen CL. Timely diagnosis and treatment of sleep apnea reduce cardiovascular sequelae in patients with myocardial infarction. PLoS One 2018; 13:e0201493. [PMID: 30059554 PMCID: PMC6066237 DOI: 10.1371/journal.pone.0201493] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/16/2018] [Indexed: 02/04/2023] Open
Abstract
Background The present study aimed to test if the temporal sequence between sleep apnea (SA) diagnosis and incident myocardial infarction (MI) was associated with the long-term mortality and cardiovascular event in a community-based cohort. Methods We retrieved data from 9,453 incident MI patients between Jan. 1st 2000 and Dec. 31st 2012 from the Taiwan National Health Insurance Research Database. The study subjects included 207 MI patients with SA (SA-MI), further stratified into 110 with pre-existing SA before MI (SA-bMI) and 96 diagnosed with SA after MI (SA-pMI). The median follow-up period was 4.2 years. Propensity-score-matched controls were selected from 9,246 non-SA MI patients (non-SA-MI). The association of SA and outcomes including all-cause mortality and major adverse cardiac and cerebrovascular events (MACCEs) were analyzed by a Cox proportional hazards model. Results The result showed that SA was not associated with mortality regardless of the timing of SA diagnosis. SA-pMI was associated with increased risk of MACCEs (Hazard ratio [HR]: 1.412, 95% confidence interval [CI]: 1.037~1.923, p = 0.029) including re-MI or revascularization and ischemic heart disease hospitalization. Such an association was most significant for SA diagnosed within one year after MI (HR: 2.029, 95% CI: 1.265~3.254, p = 0.003), which was not seen in patients treated with continuous positive airway pressure (CPAP). Conclusion The temporal sequence and the time interval between SA diagnosis and incident MI was associated with the cardiovascular events after MI, especially within one year after MI. Early assessment for the presence of SA after incident MI and early CPAP intervention may reduce the risk of further adverse cardiovascular events.
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Affiliation(s)
- Ming-Tzer Lin
- Department of Internal Medicine, Hsiao Chung-Cheng Hospital, New Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Center of Sleep Disorder, National Taiwan University Hospital, Taipei, Taiwan
| | - Chao-Lun Lai
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
- Center for Critical Care Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Pei-Lin Lee
- Center of Sleep Disorder, National Taiwan University Hospital, Taipei, Taiwan
- Departments of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Center for electronics technology integration, National Taiwan University, Taipei, Taiwan
- * E-mail: (CLC); (PLL)
| | - Min-Huei Shen
- Departments of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chong-Jen Yu
- Departments of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Tai Fang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Departments of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Ling Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Center for electronics technology integration, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail: (CLC); (PLL)
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Kiyokuni M, Kawashima C, Konishi M, Sakamaki K, Iwata K, Nakayama N, Komura N, Kosuge M, Sugano T, Ishigami T, Endo T, Ishikawa T, Yamanaka T, Kimura K, Tamura K. Relationship between sleep-disordered breathing and renal dysfunction in acute coronary syndrome. J Cardiol 2017; 71:168-173. [PMID: 29249245 DOI: 10.1016/j.jjcc.2017.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/01/2017] [Accepted: 07/21/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is associated with cardiovascular complications. However, the effect of SDB on renal function in patients with acute coronary syndrome (ACS) treated by percutaneous coronary intervention (PCI) remains unclear. METHODS We enrolled 154 consecutive ACS patients without heart failure. A sleep study was performed immediately after PCI. RESULTS The mean apnea-hypopnea index (AHI) was 16.4±13.1, and 33 patients (21%) had severe SDB, defined as AHI≥25. Estimated glomerular filtration rate (eGFR) values on admission (60±12mL/min/1.73m2 vs. 67±17mL/min/1.73m2, p=0.046) and at discharge (54±15mL/min/1.73m2 vs. 63±15mL/min/1.73m2, p=0.002) were lower in patients with severe SDB than in those patients without severe SDB. Multiple linear regression analysis showed that AHIs were significantly correlated with absolute changes in eGFR values from admission to discharge (β=0.201, p=0.004). Median 24-h urinary noradrenaline excretion measured on the same day of the sleep study was higher [297 (interquartile range {IQR}: 232-472) vs. 174 (IQR: 107-318)μg/day, p=0.021] in patients with severe SDB. On multivariate logistic regression analysis, the presence of severe SDB was a significant predictor (adjusted odds ratio 3.76, 95% confidence interval 1.06-13.9, p=0.047) for eGFR of less than 45mL/min/1.73m2 at discharge. This association was independent of age, eGFR on admission, and a presentation of ST-segment elevation myocardial infarction. CONCLUSION In patients with ACS who undergo PCI, severe SDB is associated with impaired renal function on admission and its deterioration during hospitalization. Further studies will be needed to conclude that SDB would be a therapeutic target in ACS.
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Affiliation(s)
- Masayoshi Kiyokuni
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Chika Kawashima
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Masaaki Konishi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
| | - Kentaro Sakamaki
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Kiwamu Iwata
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Naoki Nakayama
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Naohiro Komura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Teruyasu Sugano
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Tomoaki Ishigami
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Tsutomu Endo
- Division of Cardiology, Saiseikai Yokohama Southern Hospital, Yokohama, Japan
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Takeharu Yamanaka
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan
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Differential likelihood of NSTEMI vs STEMI in patients with sleep apnea. Int J Cardiol 2017; 248:64-68. [DOI: 10.1016/j.ijcard.2017.06.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 05/29/2017] [Accepted: 06/09/2017] [Indexed: 01/15/2023]
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Huang Z, Zheng Z, Luo Y, Li S, Zhu J, Liu J. Prevalence of sleep-disordered breathing in acute coronary syndrome: a systemic review and meta-analysis. Sleep Breath 2017; 21:217-226. [PMID: 27549104 DOI: 10.1007/s11325-016-1398-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 07/23/2016] [Accepted: 08/08/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE This study aimed to review the literature on the prevalence of sleep-disordered breathing (SDB) in patients with acute coronary syndrome (ACS). METHODS Relevant studies were searched on PubMed, EMBASE, and Cochrane Library through December 2014. Data were extracted using standardized forms. Pooled prevalence of all SDB (apnea-hypopnea index (AHI) > 5), moderate-to-severe SDB (AHI > 15), and severe SDB (AHI > 30) in ACS patients was calculated using DerSimonian-Laird random-effects model. Sensitivity analysis was performed based on races and diagnostic methods of SDB. RESULTS A total of 32 studies were included in the present meta-analysis, examining 3360 patients. The meta-analysis indicated that pooled prevalence of all SDB (AHI > 5), moderate-to-severe SDB (AHI > 15), and severe SDB (AHI > 30) in ACS patients were 69 % (95 % confidence interval (CI) = 61, 77 %), 43 % (95 % CI = 36, 49 %), and 25 % (95 % CI = 17, 33 %), respectively. Sensitivity analysis indicated that the pooled prevalence of SDB in Western population was similar to that in Asian population. However, diagnostic methods of SDB seemed to have various impacts on the prevalence of all SDB (AHI > 5), moderate-to-severe SDB (AHI > 15), and severe SDB (AHI > 30). CONCLUSIONS High prevalence of all SDB, moderate-to-severe SDB, and severe SDB was found in ACS patients. It is clinically important to screen for SDB in patients with ACS.
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Affiliation(s)
- Zhuoshan Huang
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhengda Zheng
- Department of Cardiology, The Third Affiliated Hospital, Sun Yat-sen University, Tianhe Road, Guangzhou, 510630, China
| | - Yanting Luo
- Department of Cardiology, The Third Affiliated Hospital, Sun Yat-sen University, Tianhe Road, Guangzhou, 510630, China
| | - Suhua Li
- Department of Cardiology, The Third Affiliated Hospital, Sun Yat-sen University, Tianhe Road, Guangzhou, 510630, China
| | - Jieming Zhu
- Department of Cardiology, The Third Affiliated Hospital, Sun Yat-sen University, Tianhe Road, Guangzhou, 510630, China
| | - Jinlai Liu
- Department of Cardiology, The Third Affiliated Hospital, Sun Yat-sen University, Tianhe Road, Guangzhou, 510630, China.
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Nagubadi S, Mehta R, Abdoh M, Nagori M, Littleton S, Gueret R, Tulaimat A. The Accuracy of Portable Monitoring in Diagnosing Significant Sleep Disordered Breathing in Hospitalized Patients. PLoS One 2016; 11:e0168073. [PMID: 27992566 PMCID: PMC5167272 DOI: 10.1371/journal.pone.0168073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 11/27/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Polysomnograms are not always feasible when sleep disordered breathing (SDB) is suspected in hospitalized patients. Portable monitoring is a practical alternative; however, it has not been recommended in patients with comorbidities. OBJECTIVE We evaluated the accuracy of portable monitoring in hospitalized patients suspected of having SDB. DESIGN Prospective observational study. SETTING Large, public, urban, teaching hospital in the United States. PARTICIPANTS Hospitalized patients suspected of having SDB. METHODS Patients underwent portable monitoring combined with actigraphy during the hospitalization and then polysomnography after discharge. We determined the accuracy of portable monitoring in predicting moderate to severe SDB and the agreement between the apnea hypopnea index measured by portable monitor (AHIPM) and by polysomnogram (AHIPSG). RESULTS Seventy-one symptomatic patients completed both tests. The median time between the two tests was 97 days (IQR 25-75: 24-109). Forty-five percent were hospitalized for cardiovascular disease. Mean age was 52±10 years, 41% were women, and the majority had symptoms of SDB. Based on AHIPSG, SDB was moderate in 9 patients and severe in 39. The area under the receiver operator characteristics curve for AHIPM was 0.8, and increased to 0.86 in patients without central sleep apnea; it was 0.88 in the 31 patients with hypercapnia. For predicting moderate to severe SDB, an AHIPM of 14 had a sensitivity of 90%, and an AHIPM of 36 had a specificity of 87%. The mean±SD difference between AHIPM and AHIPSG was 2±29 event/hr. CONCLUSION In hospitalized, symptomatic patients, portable monitoring is reasonably accurate in detecting moderate to severe SDB.
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Affiliation(s)
- Swamy Nagubadi
- Division of Pulmonary, Critical Care and Sleep Medicine, Cook County Health and Hospitals System, Chicago, Illinois, United States of America
| | - Rohit Mehta
- Division of Pulmonary, Critical Care and Sleep Medicine, Cook County Health and Hospitals System, Chicago, Illinois, United States of America
| | - Mamoun Abdoh
- Division of Pulmonary, Critical Care and Sleep Medicine, Cook County Health and Hospitals System, Chicago, Illinois, United States of America
| | - Mohammedumer Nagori
- Division of Pulmonary, Critical Care and Sleep Medicine, Cook County Health and Hospitals System, Chicago, Illinois, United States of America
| | - Stephen Littleton
- Division of Pulmonary, Critical Care and Sleep Medicine, Cook County Health and Hospitals System, Chicago, Illinois, United States of America
| | - Renaud Gueret
- Division of Pulmonary, Critical Care and Sleep Medicine, Cook County Health and Hospitals System, Chicago, Illinois, United States of America
| | - Aiman Tulaimat
- Division of Pulmonary, Critical Care and Sleep Medicine, Cook County Health and Hospitals System, Chicago, Illinois, United States of America
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Abstract
Sleep apnoea is a disorder characterised by repetitive pauses in breathing during sleep caused by airway occlusion (obstructive sleep apnoea) or altered control of breathing (central sleep apnoea). In this Clinical Year in Review, we summarise high-impact research from the past year pertaining to management, diagnosis and cardio-metabolic consequences of sleep apnoea.
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Affiliation(s)
- Jonathan C Jun
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Swati Chopra
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Alan R Schwartz
- Dept of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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Apnea obstructiva del sueño y cardiopatía isquémica. Las evidencias de su relación. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2015; 85:16-22. [DOI: 10.1016/j.acmx.2014.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 05/11/2014] [Accepted: 05/14/2014] [Indexed: 11/21/2022] Open
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Buchner S, Eglseer M, Debl K, Hetzenecker A, Luchner A, Husser O, Stroszczynski C, Hamer OW, Fellner C, Zeman F, Pfeifer M, Arzt M. Sleep disordered breathing and enlargement of the right heart after myocardial infarction. Eur Respir J 2014; 45:680-90. [DOI: 10.1183/09031936.00057014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Structural and functional integrity of the right heart is important in the prognosis after acute myocardial infarction (AMI). The objective of this study was to assess the impact of sleep disordered breathing (SDB) on structure and function of the right heart early after AMI.54 patients underwent cardiovascular magnetic resonance 3–5 days and 12 weeks after AMI, and were stratified according to the presence of SDB, defined as an apnoea–hypopnoea index of ≥15 events·h−1.12 weeks after AMI, end-diastolic volume of the right ventricle had increased significantly in patients with SDB (n=27)versusthose without (n=25) (mean±sd14±23%versus0±17%, p=0.020). Multivariable linear regression analysis accounting for age, sex, body mass index, smoking, left ventricular mass and left ventricular end-systolic volume showed that the apnoea–hypopnoea index was significantly associated with right ventricular end-diastolic volume (B-coefficient 0.315 (95% CI 0.013–0.617); p=0.041). From baseline to 12 weeks, right atrial diastolic area increased more in patients with SDB (2.9±3.7 cm2versus1.0±2.4 cm2, p=0.038; when adjusted for left ventricular end systolic volume, p=0.166).SDB diagnosed shortly after AMI predicts an increase of right ventricular end-diastolic volume and possibly right atrial area within the following 12 weeks. Thus, SDB may contribute to enlargement of the right heart after AMI.
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Sleep apnea prevalence in acute myocardial infarction--the Sleep Apnea in Post-acute Myocardial Infarction Patients (SAPAMI) Study. Int J Cardiol 2014; 176:13-9. [PMID: 25064202 DOI: 10.1016/j.ijcard.2014.06.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 05/29/2014] [Accepted: 06/20/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND While sleep apnea (SA) might be a modifiable cardiovascular risk factor, recent data suggest that SA is severely underdiagnosed in patients after acute myocardial infarction (MI). There is limited evidence about day-night variation of onset of MI on dependence of having SA. We therefore investigated the prevalence of SA and examined the day-night variation of onset of MI in acute MI patients. METHODS We prospectively studied 782 consecutive patients admitted to the hospital with the diagnosis of acute MI. All subjects underwent sleep evaluations using a portable device after at least 48 h post-admission. Using the apnea-hypopnea index (AHI), groups were defined as patients without SA (<5 events/h), mild SA (5-15 events/h), moderate SA (15-30 events/h), and severe SA (≥ 30 events/h). RESULTS Almost all patients (98%) underwent urgent coronary angiography and 91% of patients underwent primary PCI. Using a threshold of AHI ≥ 5 events/h, SA was present in 65.7% of patients after acute MI. Mild SA was present in 32.6%, moderate in 20.4% and severe in 12.7%. The day-night variation in the onset of MI in all groups of SA patients was similar to that observed in non-SA patients. From 6 AM to 12 PM, the frequency of MI was higher in both SA and non-SA patients, as compared to the interval from 12 AM to 6 AM (all p<0.05). CONCLUSION There is a high prevalence of SA in patients presenting with acute MI. Peak time of MI onset in SA patients was between 6 AM and noon, similar to that in the general population. Whether diagnosis and treatment of SA after MI will significantly improve outcomes in these patients remains to be determined.
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Carpio C, Álvarez-Sala R, García-Río F. Epidemiological and Pathogenic Relationship between Sleep Apnea and Ischemic Heart Disease. Pulm Med 2013; 2013:405827. [PMID: 23862060 PMCID: PMC3703797 DOI: 10.1155/2013/405827] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 05/28/2013] [Indexed: 01/31/2023] Open
Abstract
Obstructive sleep apnea is recognized as having high prevalence and causing remarkable cardiovascular risk. Coronary artery disease has been associated with obstructive sleep apnea in many reports. The pathophysiology of coronary artery disease in obstructive sleep apnea patients probably includes the activation of multiple mechanisms, as the sympathetic activity, endothelial dysfunction, atherosclerosis, and systemic hypertension. Moreover, chronic intermittent hypoxia and oxidative stress have an important role in the pathogenesis of coronary disease and are also fundamental to the development of atherosclerosis and other comorbidities present in coronary artery diseases such as lipid metabolic disorders. Interestingly, the prognosis of patients with coronary artery disease has been associated with obstructive sleep apnea and the severity of sleep disordered breathing may have a direct relationship with the morbidity and mortality of patients with coronary diseases. Nevertheless, treatment with CPAP may have important effects, and recent reports have described the benefits of obstructive sleep apnea treatment on the recurrence of acute heart ischaemic events in patients with coronary artery disease.
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Affiliation(s)
- Carlos Carpio
- Servicio de Neumología, Hospital Universitario La Paz, Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), 28046 Madrid, Spain
| | - Rodolfo Álvarez-Sala
- Servicio de Neumología, Hospital Universitario La Paz, Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), 28046 Madrid, Spain
| | - Francisco García-Río
- Servicio de Neumología, Hospital Universitario La Paz, Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), 28046 Madrid, Spain
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Hayashi H, Fukuma N, Kato K, Kato Y, Takahashi H, Mizuno K. Clinical Backgrounds and the Time Course of Sleep-disordered Breathing in Patients after Myocardial Infarction. J NIPPON MED SCH 2013; 80:192-9. [DOI: 10.1272/jnms.80.192] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Hiroko Hayashi
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Nagaharu Fukuma
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Kazuyo Kato
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Yuko Kato
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | - Kyoichi Mizuno
- Department of Cardiovascular Medicine, Nippon Medical School
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Shah N, Redline S, Yaggi HK, Wu R, Zhao CG, Ostfeld R, Menegus M, Tracy D, Brush E, Appel WD, Kaplan RC. Obstructive sleep apnea and acute myocardial infarction severity: ischemic preconditioning? Sleep Breath 2012; 17:819-26. [PMID: 23090861 DOI: 10.1007/s11325-012-0770-7] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 09/24/2012] [Accepted: 09/26/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is characterized by intermittent hypoxia (IH). In animal models, IH has been shown to protect the myocardium during periods of ischemia by reducing infarct size. However, this phenomenon of "ischemic preconditioning" has not been investigated among OSA patients with acute myocardial infarction (MI). This study investigates the role of OSA on MI severity as measured by cardiac enzymes, specifically troponin-T, among patients with an acute MI. METHODS This is an observational cohort study of patients ≥18 years of age who were hospitalized with an acute MI. Each participant underwent portable sleep monitoring (Apnea Link Plus); OSA was defined as an apnea-hypopnea index ≥5/h. Multivariable regression analysis was conducted to assess the relationship between OSA and highly sensitive troponin-T levels. RESULTS In our entire cohort of acute MI patients (n = 136), 77 % of the sample had evidence of sleep disordered breathing, with 35 % of the sample having OSA (i.e., an AHI >5). Higher AHI was associated with lower peak troponin-T levels in partially adjusted models (β = -0.0320, p = 0.0074, adjusted for age, gender, and race) and fully adjusted models (β = -0.0322, p = 0.0085) (additionally adjusted for smoking, hypertension, hyperlipidemia, body mass index, history of prior cardiovascular or cerebrovascular disease, diabetes and baseline admission creatinine levels). The mean value of the log-transformed peak troponin-T variable was used to dichotomize the outcome variable. In both partially (OR 0.949, CI 0.905-0.995, p = 0.03) and fully adjusted (OR 0.918, CI 0.856-0.984, p = 0.0151) logistic regression models, the OR for AHI suggests a protective effect on high troponin-T level. CONCLUSIONS Our study demonstrates that patients with OSA have less severe cardiac injury during an acute non-fatal MI when compared to patients without OSA. This may suggest a cardioprotective role of sleep apnea during acute MI via ischemic preconditioning.
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Affiliation(s)
- Neomi Shah
- Pulmonary Division, Department of Medicine, Montefiore Medical Center, 111 East 210th Street, Pulmonary Sleep Lab, Klau-3, Bronx, NY 10467, USA.
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Schiza SE, Simantirakis E, Bouloukaki I, Mermigkis C, Kallergis EM, Chrysostomakis S, Arfanakis D, Tzanakis N, Vardas P, Siafakas NM. Sleep disordered breathing in patients with acute coronary syndromes. J Clin Sleep Med 2012; 8:21-6. [PMID: 22334805 PMCID: PMC3266342 DOI: 10.5664/jcsm.1652] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Although the prevalence of obstructive sleep apnea/hypopnea syndrome (OSAHS) is high in patients with acute coronary syndromes (ACS), there is little knowledge about the persistence of OSAHS in ACS patients after the acute event. We aimed to assess the prevalence and time course of OSAHS in patients with ACS during and after the acute cardiac event. METHODS Fifty-two patients with first-ever ACS, underwent attended overnight polysomnography (PSG) in our sleep center on the third day after the acute event. In patients with an apnea hypopnea index (AHI) > 10/h, we performed a follow up PSG 1 and 6 months later. RESULTS Twenty-eight patients (54%) had an AHI > 10/h. There was a significant decrease in AHI 1 month after the acute event (13.9 vs. 19.7, p = 0.001), confirming the diagnosis of OSAHS in 22 of 28 patients (79%). At 6-month follow-up, the AHI had decreased further (7.5 vs. 19.7, p < 0.05), and at that time only 6 of the 28 patients (21%) were diagnosed as having OSAHS. Twelve of the 16 current smokers stopped smoking after the acute event. CONCLUSIONS We have demonstrated a high prevalence of OSAHS in ACS patients, which did not persist 6 months later, indicating that, to some degree, OSAHS may be transient and related with the acute phase of the underlying disease or the reduction in the deleterious smoking habit.
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Affiliation(s)
- Sophia E Schiza
- Sleep Disorders Unit, Department of Thoracic Medicine, Medical School, University of Crete, Greece.
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Nakashima H, Muto S, Amenomori K, Shiraishi Y, Nunohiro T, Suzuki S. Impact of obstructive sleep apnea on myocardial tissue perfusion in patients with ST-segment elevation myocardial infarction. Circ J 2011; 75:890-6. [PMID: 21301132 DOI: 10.1253/circj.cj-10-0768] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Vascular endothelial dysfunction has been recognized as an essential feature of obstructive sleep apnea (OSA). This study was designed to examine the hypothesis that OSA may impair the coronary microcirculation in patients with ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS The present study included 100 patients with a first STEMI who underwent primary percutaneous coronary intervention (PCI) within 12h from onset. Coronary flow velocity at baseline and at maximum hyperemia was measured using a Doppler guidewire following PCI. Total ST-segment elevation was calculated at baseline and 30 min after PCI. All patients underwent polysomnography at 14 days to diagnose OSA. Coronary flow velocity reserve (CFVR) was used for quantitative analysis of myocardial tissue perfusion. Systolic retrograde flow (SRF) and ST-segment resolution (STR) <50% were used as an index of microvascular injury. Forty-eight patients presented with OSA. CFVR was comparable between the 2 groups. The incidence of SRF was higher in OSA patients than in the control patients (6% vs. 31%, P=0.005). Patients with OSA had a higher incidence of STR <50% (31% vs. 60%, P=0.003). Multiple logistic regression showed that OSA was an independent positive predictor of SRF and STR <50% (odds ratio=4.46, P=0.044; odds ratio=3.79, P=0.010). CONCLUSIONS OSA may impair myocardial tissue perfusion following primary PCI.
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Affiliation(s)
- Hiroshi Nakashima
- Department of Cardiology, Nagasaki Citizens Hospital, 6-39 Shinchi-machi, Nagasaki 850-8555, Japan.
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Takama N, Matsuo Y, Arai H, Yamagishi T, Eguma H, Kurabayashi M. Integrated area of desaturation index in patients with myocardial infarction. Int J Cardiol 2010; 143:425-8. [DOI: 10.1016/j.ijcard.2008.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Accepted: 12/03/2008] [Indexed: 10/21/2022]
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Peak time of acute coronary syndrome in patients with sleep disordered breathing. J Cardiol 2009; 53:164-70. [DOI: 10.1016/j.jjcc.2008.09.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 08/05/2008] [Accepted: 09/30/2008] [Indexed: 11/20/2022]
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BaHammam AS. Does Sleep Apnea Change Over Time in Patients With Acute Myocardial Infarction? Circ J 2007; 71:804; author reply 804-5. [PMID: 17518008 DOI: 10.1253/circj.71.804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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