Behaviour and time-course of sleep disordered breathing in patients with acute coronary syndromes

Abstract

To our knowledge, no study has examined the persistence of sleep disordered breathing in acute coronary syndrome (ACS) patients. We examined the time course of SDB in ACS patients by assessing them within days of the acute event and again after 6 months. Consecutive patients with ACS were asked to voluntarily participate in the study. Patients underwent an overnight polysomnography (PSG) approximately 3 days after the acute event. Patients with an apnea hypopnea index (AHI) > 10/h then underwent another PSG after they were stable (approximately 6 months). Fifty patients were studied. First PSG showed an AHI was 23.1 +/- 3.6/h. A second PSG was performed 6.1 +/- 0.3 months later on 21 patients and showed an AHI > 10/h in the first assessment. The AHI and the obstructive apnea index did not change over the 6 months. However, the central apnea index all was lower at the second assessment.

Sleep Disordered Breathing in Patients with Acute Coronary Syndromes

“…19,20,25 The present study was performed to investigate the time course of OSAHS in a homogeneous group of patients with ACS and preserved left ventricular function, who were not mechanically ventilated or on oral or intravenous sedation. To try to explain the association between ACS and OSAHS, patient selection was strict enough to exclude other comorbidities (details in the materials and methods section) that may be causative related to OSAHS.…”

“…However, our findings seem to contradict those previously reported by Bahammam et al, who showed a high prevalence of OSAHS persisting at 6 months after the acute cardiac event. 20 The question of the ideal timing of an investigation for OSAHS after an acute cardiovascular event remains unresolved. It is well known that making the diagnosis of OSAHS in patients with cardiovascular disease is important, particularly given that adequate management improves its cardiovascular consequences.…”

“…19,20,[22][23][24]31 Furthermore, the patient samples were heterogeneous, since conditions that could increase the prevalence of OSAHS-confused patients, patients who had received sedatives or narcotics, and patients with chronic obstructive pulmonary disease, severe bronchial asthma, or stroke-were not excluded. 18,19,23,24 Moreover, sleep position and the fact that, as sensors need to be attached, patients are more likely to lay supine in the coronary care unit (CCU) or sleep laboratory setting as opposed to their own home, was not taken into consideration.…”

“…Although an increased incidence of CAD has been found in patients with OSAHS, 13,14 and even mild to moderate OSAHS has been associated with a worse prognosis in patients with existing CAD, 15,16 the characterization of OSAHS in the acute myocardial ischemia setting is less clear. [17][18][19][20][21][22][23][24][25] Based on the results of recent studies 19,20,25 it is diffi cult to determine whether OSAHS contributes to the occurrence of ACS, or whether OSAHS is a consequence of the acute phase in ACS patients that may improve after medical stabilisation. We therefore conducted a longitudinal study to assess the prevalence of OSAHS in a homogeneous group of patients with ACS, who had no other medical or known sleep disorder, to examine whether OSAHS persists over time and to elucidate any possible connection with the severity of the underlying disease.…”

Obstructive Sleep Apnea: From Simple Upper Airway Obstruction to Systemic Inflammation

“…In Saudi Arabia, three of ten Saudi middle-aged men and four of ten Saudi middle-aged women are at a high risk of OSA 45. Additionally, 56% of Saudi patients admitted to the coronary care unit with acute coronary syndrome were diagnosed as having OSA with an apnea hypopnea index >10/hour 6. The pandemic of obesity has increased the risk of OSA, and the prevalence of obesity is expected to increase.…”