Sleep apnoea is associated with major cardiac events in peripheral arterial disease

Abstract

Obstructive sleep apnoea (OSA) is associated with atherosclerosis and cardiovascular events. Peripheral arterial disease (PAD) represents severe atherosclerosis with a high mortality after vascular surgery. The role of OSA in the prognosis of these patients is not yet established.84 patients (aged 67¡9 years) scheduled for sub-inguinal surgical revascularisation were enrolled for preoperative polysomnography. The threshold for significant OSA was an apnoea/hypopnoea index o20 events?h -1 . Major adverse cardiovascular and cerebrovascular events (MACCE), including cardiac death, myocardial infarction, coronary revascularisation, angina pectoris requiring hospitalisation and stroke, were used as a combined end-point.During follow-up (median 52 months), 17 out of 39 patients with and six out of 45 patients without significant OSA suffered MACCE. In the multivariate Cox regression, the primary predictors of MACCE were significant OSA (hazard ratio (HR) 5.1 (95% CI 1.9-13.9); p50.001) and pre-existing coronary artery disease (HR 4.4 (95% CI 1.8-10.6); p50.001). Other significant predictors were a o4 year history of PAD (HR 3.8 (95% CI 1.3-11.5); p50.02) and decreasing high-density lipoprotein/total cholesterol ratio (HR 0.95 per percentage (95% CI 0.90-1.00); p50.048).OSA is associated with poor long-term outcome in patients with PAD following revascularisation. OSA might have an important role in the pathogenesis of cardiovascular morbidity and mortality in these patients. @ERSpublications Sleep apnoea is associated with poor long-term outcome in peripheral arterial disease patients undergoing surgery

Effect of continuous positive airway pressure therapy on inflammatory cytokines and atherosclerosis in patients with obstructive sleep apnea syndrome

“…In patients with OSAS with significant characteristics of upper airway collapse (19) and effects on the circulatory system, the primary mechanism involves the excitement of sympathetic nerves (3), increase of endothelin levels (20), vascular endothelial function, abnormalities in vascular active substances (21), vascular tension (22) and excessive renin secretion causing sustained hypertension (23). In previous studies, plasma levels of CRP and other inflammatory cytokines in patients with OSAS caused by inflammation have been reported to promote cardiovascular and cerebrovascular diseases (24), including AS.…”

Sleep Study and Oximetry Parameters for Predicting Postoperative Complications in Patients With OSA

“…In a 1-year follow-up study in 84 patients undergoing surgical revascularization for peripheral artery disease, an AHI $ 20 was predictive of major adverse cardiovascular and cerebrovascular events (hazard ratio, 5.1). 35 Lastly, a study in 471 patients who had undergone various noncardiac or upper airway surgeries under general anesthetic, Kaw et al 36 reported that a diagnosis of OSA (as defined by an AHI $ 5 events per hour) was associated with increased risk of postoperative hypoxemia, admission to the ICU, and longer hospital length of stay. No relationship between the AHI and postoperative complications was reported.…”

Sleep-Disordered Breathing and Peripheral Arterial Disease: Current Evidence

“…A further 525 records were removed after screening by titles and abstracts. We carefully read the full texts of the remaining 16 papers and then excluded 8 additional articles [11][12][13][14][15][16][17][18] for the following reasons: (1) a review, (2) no extractable data, (3) overlapping data, (4) Burger disease, and (5) PAD not clearly identified as a cardiovascular event. Ultimately, the review included 8 articles.…”