1
|
Zhang Y, Hao W, Fan J, Guo R, Ai H, Que B, Wang X, Dong J, Nie S. Association Between Obstructive Sleep Apnea and Cardiovascular Events in Acute Coronary Syndrome Patients With or Without Revascularization - A Prospective Cohort Study. Circ J 2023; 87:1369-1379. [PMID: 37612051 DOI: 10.1253/circj.cj-23-0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
BACKGROUND The effects of obstructive sleep apnea (OSA) on the prognosis of acute coronary syndrome (ACS) without revascularization remain unclear, so the aim of the present study was to elucidate the association of OSA with subsequent cardiovascular events in ACS patients with and without revascularization. METHODS AND RESULTS We prospectively recruited hospitalized ACS patients undergoing sleep monitoring between June 2015 and January 2020. OSA was defined as an apnea-hypopnea index ≥15 events/h. The primary endpoint was a major adverse cardiovascular and cerebrovascular event (MACCE), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure. Among 1,927 patients, 52.6% had OSA and 69.4% underwent revascularization. During a 2.9-year follow-up (1.5-3.6 years), the risk of MACCE was similar in patients with or without revascularization. OSA was an independent predictor of MACCE in the non-revascularization group (22.6% vs. 14.6%; hazard ratio (HR) 1.861; 95% confidence interval (CI) 1.239-2.796; P=0.003) but not in revascularization group (22.3% vs. 19.3%; HR 1.135; 95% CI 0.882-1.460; P=0.324). The incremental risk in the non-revascularization group was attributable to more hospitalizations for unstable angina (14.2% vs. 8.6%; HR 1.896; 95% CI 1.124-3.199; P=0.016). CONCLUSIONS For patients with ACS, OSA was independently associated with higher risk of recurrent cardiovascular events among patients without revascularization but not among patients undergoing revascularization. The benefits of suitable OSA treatment for patients without revascularization need further investigation.
Collapse
Affiliation(s)
- Ying Zhang
- Division of Cardiology, Beijing Anzhen Hospital, National Clinical Research Center for Cardiovascular Diseases, Capital Medical University
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University
| | - Wen Hao
- Division of Cardiology, Beijing Anzhen Hospital, National Clinical Research Center for Cardiovascular Diseases, Capital Medical University
| | - Jingyao Fan
- Division of Cardiology, Beijing Anzhen Hospital, National Clinical Research Center for Cardiovascular Diseases, Capital Medical University
| | - Ruifeng Guo
- Division of Cardiology, Beijing Anzhen Hospital, National Clinical Research Center for Cardiovascular Diseases, Capital Medical University
| | - Hui Ai
- Division of Cardiology, Beijing Anzhen Hospital, National Clinical Research Center for Cardiovascular Diseases, Capital Medical University
| | - Bin Que
- Division of Cardiology, Beijing Anzhen Hospital, National Clinical Research Center for Cardiovascular Diseases, Capital Medical University
| | - Xiao Wang
- Division of Cardiology, Beijing Anzhen Hospital, National Clinical Research Center for Cardiovascular Diseases, Capital Medical University
| | - Jianzeng Dong
- Division of Cardiology, Beijing Anzhen Hospital, National Clinical Research Center for Cardiovascular Diseases, Capital Medical University
| | - Shaoping Nie
- Division of Cardiology, Beijing Anzhen Hospital, National Clinical Research Center for Cardiovascular Diseases, Capital Medical University
| |
Collapse
|
2
|
Peker Y, Thunström E, Glantz H, Eulenburg C. Effect of Obstructive Sleep Apnea and CPAP Treatment on Cardiovascular Outcomes in Acute Coronary Syndrome in the RICCADSA Trial. J Clin Med 2020; 9:jcm9124051. [PMID: 33333899 PMCID: PMC7765306 DOI: 10.3390/jcm9124051] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 12/15/2022] Open
Abstract
We aimed to address the impact of OSA and its treatment with continuous positive airway pressure (CPAP) on major adverse cardiovascular and cerebrovascular events (MACCE) in patients with acute coronary syndrome (ACS). In this current analysis of the revascularized ACS subgroup (n = 353) of the Randomized Intervention with CPAP in Coronary Artery Disease and Obstructive Sleep Apnea (RICCADSA) trial (Trial Registry: ClinicalTrials.gov; No: NCT 00519597), participants with non-sleepy OSA (apnea-hypopnea-index [AHI] ≥ 15 events/h on a home sleep apnea testing, and Epworth Sleepiness Scale [ESS] score < 10; n = 171) were randomized to CPAP (n = 86) or no-CPAP (n = 85). The sleepy OSA patients (AHI ≥ 15 events/h and ESS ≥ 10) who were offered CPAP, and the ones with no-OSA (AHI < 5 events/h) were included in the observational arm. A post-hoc analysis was done to compare untreated OSA (no-CPAP; n = 78) and nonadherent sleepy/non-sleepy OSA (n = 96) with the reference group without OSA (n = 81). The primary endpoint (the first event of repeat revascularization, myocardial infarction, stroke or cardiovascular mortality) during a median 4.7-year follow-up was evaluated in time-dependent Cox proportional hazards models adjusted for confounding factors. The incidence of MACCE did not differ significantly in intention-to-treat population. On-treatment analysis showed a significant risk reduction in those who used CPAP for ≥4 vs. <4 h/day or did not receive treatment (adjusted hazard ratio [HR] 0.17; 95% confidence interval [CI] 0.03–0.81; p = 0.03). Compared with the reference group, nonadherent/untreated OSA was associated with an increased cardiovascular risk (adjusted HR 1.97, 95% CI 1.03–3.77; p = 0.04). We conclude that OSA is an independent risk factor for adverse cardiovascular outcomes in patients with ACS. CPAP treatment may reduce this risk, if the device is used at least 4 h/day.
Collapse
Affiliation(s)
- Yüksel Peker
- Department of Pulmonary Medicine, Koc University School of Medicine, TR 34010 Istanbul, Turkey
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, SE 40530 Gothenburg, Sweden;
- Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, SE 22185 Lund, Sweden
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- Correspondence: ; Tel.: +90-544-348-3866
| | - Erik Thunström
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, SE 40530 Gothenburg, Sweden;
- Department of Cardiology, Sahlgrenska University Hospital/Östra, 41345 Gothenburg, Sweden
| | - Helena Glantz
- Department of Internal Medicine, Skaraborg Hospital, SE 53185 Lidköping, Sweden;
| | - Christine Eulenburg
- Department for Epidemiology, University of Groningen, 9712 CP Groningen, The Netherlands;
| |
Collapse
|
3
|
Ramírez J, Rodriquez D, Urbina A, Cardenas A, Lipomi DJ. Combining High Sensitivity and Dynamic Range: Wearable Thin-Film Composite Strain Sensors of Graphene, Ultrathin Palladium, and PEDOT:PSS. ACS APPLIED NANO MATERIALS 2019; 2:2222-2229. [PMID: 33829151 PMCID: PMC8023279 DOI: 10.1021/acsanm.9b00174] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Wearable mechanical sensors have the potential to transform healthcare by enabling patient monitoring outside of the clinic. A critical challenge in the development of mechanical-e.g., strain-sensors is the combination of sensitivity, dynamic range, and robustness. This work describes a highly sensitive and robust wearable strain sensor composed of three layered materials: graphene, an ultrathin film of palladium, and highly plasticized PEDOT:PSS. The role of the graphene is to provide a conductive, manipulable substrate for the deposition of palladium. When deposited at low nominal thicknesses (~8 nm) palladium forms a rough, granular film which is highly piezoresistive (i.e., the resistance increases with strain with high sensitivity). The dynamic range of these graphene/palladium films, however, is poor, and can only be extended to ~10% before failure. This fragility renders the films incompatible with wearable applications on stretchable substrates. To improve the working range of graphene/palladium strain sensors, a layer of highly plasticized PEDOT:PSS is used as a stretchable conductive binder. That is, the conductive polymer provides an alternative pathway for electrical conduction upon cracking of the palladium film and the graphene. The result was a strain sensor that possessed good sensitivity at low strains (0.001% engineering strain) but with a working range up to 86%. The piezoresistive performance can be optimized in a wearable device by sandwiching the conductive composite between a soft PDMS layer in contact with the skin and a harder layer at the air interface. When attached to the skin of the torso, the patch-like strain sensors were capable of detecting heartbeat (small strain) and respiration (large strain) simultaneously. This demonstration highlights the ability of the sensor to measure low and high strains in a single interpolated signal, which could be useful in monitoring, for example, obstructive sleep apnea with an unobtrusive device.
Collapse
|
4
|
Baniak LM, Chasens ER, Luyster FS, Strollo PJ, Thunström E, Peker Y. Obstructive sleep apnea and self-reported functional impairment in revascularized patients with coronary artery disease in the RICCADSA trial. Sleep Breath 2018; 22:1169-1177. [PMID: 30324547 DOI: 10.1007/s11325-018-1733-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/11/2018] [Accepted: 10/02/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Daytime sleepiness, a frequent symptom of obstructive sleep apnea (OSA), can impact functional status. In patients with coronary artery disease (CAD) and concomitant OSA, the distinction between sleep-related functional impairment from underlying CAD versus OSA is unclear. This study evaluated the impact of OSA on sleep-related functional impairment in patients with CAD and compared the effect of 1-year continuous positive airway pressure (CPAP) use on change in impairment between those with and without excessive daytime sleepiness (EDS) and OSA. We hypothesized that sleep-related functional impairment is impacted by EDS independent of OSA in patients with CAD. METHODS One hundred five CAD patients without OSA and 105 with moderate-to-severe OSA from the RICCADSA trial were matched on disease severity and included in the current substudy. Of those with OSA, 80 were allocated to CPAP. Functional Outcomes of Sleep Questionnaire (FOSQ) score < 17.9 corresponded to sleep-related functional impairment. RESULTS Following revascularization, CAD patients with and without OSA frequently report sleep-related functional impairment (35% and 27.3%, respectively; p = .29). Moderate-to-severe OSA was not related to baseline FOSQ scores < 17.9 in regression analyses; EDS was (OR 4.82, 95% CI 2.12-11.0; p < .001). CPAP use significantly improved FOSQ scores from baseline to 1-year follow-up in OSA patients with EDS (17.2 ± 2.0 to 18.15 ± 1.7, p = .002) despite suboptimal adherence. CONCLUSIONS Sleep-related functional impairment may be reflective of persistent EDS, independent of OSA. Diagnosing OSA and initiating treatment are worthwhile in individuals with CAD and EDS, as both are important to guide appropriate therapy in patients with CAD.
Collapse
Affiliation(s)
- Lynn M Baniak
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Victoria Building 415, Pittsburgh, PA, 15261, USA.
| | - Eileen R Chasens
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Victoria Building 415, Pittsburgh, PA, 15261, USA
| | - Faith S Luyster
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Victoria Building 415, Pittsburgh, PA, 15261, USA
| | - Patrick J Strollo
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Erik Thunström
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden
| | - Yüksel Peker
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Pulmonary Medicine, School of Medicine, Koc University, Istanbul, Turkey.,Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden
| |
Collapse
|
5
|
Jiang XM, Qian XS, Gao XF, Ge Z, Tian NL, Kan J, Zhang JJ. Obstructive Sleep Apnea Affecting Platelet Reactivity in Patients Undergoing Percutaneous Coronary Intervention. Chin Med J (Engl) 2018; 131:1023-1029. [PMID: 29692371 PMCID: PMC5937308 DOI: 10.4103/0366-6999.230732] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: The relationship between obstructive sleep apnea (OSA) and platelet reactivity in patients undergoing percutaneous coronary intervention (PCI) has not been defined. The present prospective, single-center study explored the relationship between platelet reactivity and OSA in patients with PCI. Methods: A total of 242 patients were finally included in the study. OSA was screened overnight by polysomnography. Platelet reactivity was assessed with a sequential platelet counting method, and the platelet maximum aggregation ratio (MAR) and average aggregation ratio were calculated. All patients were assigned per apnea-hypopnea index (AHI) to non-OSA (n = 128) and OSA (n = 114) groups. The receiver operating characteristic curve analysis was used to evaluate the accuracy of AHI for high platelet reactivity (HPR) on aspirin and clopidogrel, and multivariable logistic regression was used to determine the independent predictors of HPR on aspirin and clopidogrel. Results: Median AHI was significantly higher in the OSA group than in the non-OSA group (34.5 events/h vs. 8.1 events/h, Z = −13.422, P < 0.001). Likewise, median arachidonic acid- and adenosine diphosphate-induced maximum aggregation rate (MAR) in the OSA group was significantly higher than those in the non-OSA group (21.1% vs. 17.7%, Z = −3.525, P < 0.001 and 45.8% vs. 32.2%, Z = −5.708, P < 0.001, respectively). Multivariable logistic regression showed that OSA was the only independent predictor for HPR on aspirin (odds ratio [OR]: 1.055, 95% confidence interval [CI]: 1.033–1.077, P < 0.001) and clopidogrel (OR: 1.036, 95% CI: 1.017–1.056, P < 0.001). The cutoff value of AHI for HPR on aspirin was 45.2 events/h (sensitivity 47.1% and specificity 91.3%), whereas cutoff value of AHI for HPR on clopidogrel was 21.3 events/h (sensitivity 68.3% and specificity 67.7%). Conclusion: Platelet reactivity appeared to be higher in OSA patients with PCI despite having received a loading dose of aspirin and clopidogrel, and OSA might be an independent predictor of HPR on aspirin and clopidogrel.
Collapse
Affiliation(s)
- Xiao-Min Jiang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China
| | - Xue-Song Qian
- Department of Cardiology, Zhangjiagang First People's Hospital, Zhangjiagang, Jiangsu 215699, China
| | - Xiao-Fei Gao
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China
| | - Zhen Ge
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China
| | - Nai-Liang Tian
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China
| | - Jing Kan
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China
| | - Jun-Jie Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China
| |
Collapse
|
6
|
Wang X, Fan JY, Zhang Y, Nie SP, Wei YX. Association of obstructive sleep apnea with cardiovascular outcomes after percutaneous coronary intervention: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e0621. [PMID: 29703065 PMCID: PMC5944507 DOI: 10.1097/md.0000000000010621] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The relationship between obstructive sleep apnea (OSA) and adverse cardiovascular outcomes in patients undergoing percutaneous coronary intervention (PCI) remains unclear. We performed a systematic review and meta-analysis to assess the impact of OSA on subsequent cardiovascular events after PCI.We searched the PubMed, EMBASE, and Cochrane library from their inceptions to August 5, 2017. We included cohort studies that described the association between OSA (based on apnea-hypopnea index) and cardiovascular outcomes after PCI with stenting. The primary endpoint was major adverse cardiovascular event (MACE), including all-cause or cardiovascular death, myocardial infarction, stroke, repeat revascularization, or heart failure. Outcomes data were pooled using random effects models and heterogeneity was assessed with the I statistic.We identified 9 studies with 2755 participants. The prevalence of OSA in patients treated with PCI ranged from 35.3% to 61.8%. OSA was associated with increased risk of MACE after PCI (pooled risk ratio [RR] 1.96, 95% confidence interval [CI]: 1.36-2.81, P < .001, I = 54%). Between-study heterogeneity was partially explained by sample size (2 studies with ≤100 participants; RR 9.12, 95% CI: 2.69-31.00, I = 0% vs 7 studies with >100 participants; RR 1.64, 95% CI: 1.23-2.18, I = 35%). Moreover, the presence of OSA significantly increased the incidence of all-cause death (4 studies), cardiovascular death (4 studies), and repeat revascularization (7 studies) in patients undergoing PCI.Patients with OSA are at greater risk of subsequent cardiovascular events after PCI. Whether treatment of OSA prevents such events warrants further investigation.
Collapse
Affiliation(s)
- Xiao Wang
- Emergency and Critical Care Center, Beijing Anzhen Hospital
| | - Jing-Yao Fan
- Emergency and Critical Care Center, Beijing Anzhen Hospital
| | - Ying Zhang
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University
| | - Shao-Ping Nie
- Emergency and Critical Care Center, Beijing Anzhen Hospital
| | - Yong-Xiang Wei
- Department of Otolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
7
|
Ratneswaran C, Sagoo MK, Steier J. Preface for the 3rd Clinical Update Sleep, 23rd February 2018, Royal College of Physicians, London, UK: year in review. J Thorac Dis 2018; 10:S1-S23. [PMID: 29445524 PMCID: PMC5803052 DOI: 10.21037/jtd.2017.10.162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Culadeeban Ratneswaran
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Lane Fox Unit/Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Manpreet K Sagoo
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Joerg Steier
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Lane Fox Unit/Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
8
|
Peker Y, Thunström E, Glantz H, Wegscheider K, Eulenburg C. Outcomes in coronary artery disease patients with sleepy obstructive sleep apnoea on CPAP. Eur Respir J 2017; 50:50/6/1700749. [PMID: 29217597 PMCID: PMC5898935 DOI: 10.1183/13993003.00749-2017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/31/2017] [Indexed: 01/02/2023]
Abstract
Coronary artery disease (CAD) patients with obstructive sleep apnoea (OSA) have increased risk for major adverse cardiovascular and cerebrovascular events (MACCEs) compared with CAD patients without OSA. We aimed to address if the risk is similar in both groups when OSA patients are treated.This study was a parallel observational arm of the RICCADSA randomised controlled trial, conducted in Sweden between 2005 and 2013. Patients with revascularised CAD and OSA (apnoea-hypopnoea index (AHI) ≥15 events·h-1) with daytime sleepiness (Epworth Sleepiness Scale score ≥10) were offered continuous positive airway pressure (CPAP) (n=155); CAD patients with no OSA (AHI <5 events·h-1) acted as controls (n=112), as a randomisation of sleepy OSA patients to no treatment would not be ethically feasible. The primary end-point was the first event of MACCEs. Median follow-up was 57 months.The incidence of MACCEs was 23.2% in OSA patients versus 16.1% in those with no OSA (adjusted hazard ratio 0.96, 95% CI 0.40-2.31; p=0.923). Age and previous revascularisation were associated with increased risk for MACCEs, whereas coronary artery bypass grafting at baseline was associated with reduced risk.We conclude that the risk for MACCEs was not increased in CAD patients with sleepy OSA on CPAP compared with patients without OSA.
Collapse
Affiliation(s)
- Yüksel Peker
- Dept of Pulmonary Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey .,Dept of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erik Thunström
- Dept of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Dept of Cardiology, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Helena Glantz
- Dept of Internal Medicine, Skaraborg Hospital, Lidköping, Sweden
| | - Karl Wegscheider
- Dept of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Eulenburg
- Medical Statistics and Decision Making, Dept of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
9
|
Patients with symptoms and characteristics consistent with obstructive sleep apnea are at a higher risk for acute and subacute stent thrombosis after percutaneous coronary stent implantation: a single-center case-control study. BMC Cardiovasc Disord 2017; 17:226. [PMID: 28821224 PMCID: PMC5562978 DOI: 10.1186/s12872-017-0658-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/07/2017] [Indexed: 01/12/2023] Open
Abstract
Background To determine if obstructive sleep apnea (OSA) is a risk factor for early stent thrombosis (EST; within 30 days) after percutaneous coronary intervention (PCI). Methods This case–control study involved 23 patients with angiographically confirmed EST after PCI (case group) and 92 PCI patients (control group) who did not develop stent thrombosis during a 2-year follow-up. Patients with symptoms and characteristics consistent with OSA (hereinafter referred to as OSA) were identified using the Berlin questionnaire, and the general characteristics of the patients and their treatments as well as outcomes were recorded. The odds ratios (ORs) for OSA were calculated. Additionally, the association between OSA and EST in patients with different conventional cardiovascular risk factors was analyzed. Results The crude OR for OSA was 4.17 (95% confidence interval [CI]: 1.60–10.84, P = 0.003). After adjusting for other risk factors of EST, the OR for OSA remained significant. In participants with no or one conventional cardiovascular disease risk factor, we found a significant association between OSA and EST (OR: 17.00, 95% CI: 2.33–124.19, P = 0.005). Conclusion OSA is an independent risk factor for EST. This conclusion was further supported by the finding that in patients with few conventional cardiovascular risk factors, the contribution of OSA to EST was more obvious.
Collapse
|