Central sleep apnea after acute coronary syndrome and association with ticagrelor use

Meurin, Philippe; Driss, Ahmed Ben; Defrance, C.; Dumaine, Raphaelle; Weber, Hannelore; Renaud, Nathalie; Bonnevie, L.; Mouram, Sahar; Tabet, Jean-Yves

doi:10.1016/j.sleep.2021.01.026

Cited by 8 publications

(4 citation statements)

References 22 publications

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“…A single-center prospective study of patients within 1 year of ACS by Meurin et al, in which a sleep study was performed on all patients, showed strikingly higher prevalence of CSA in patients taking ticagrelor versus clopidogrel (30% vs. 7.3%). 9 Our study similarly supports a relationship between CSA and ticagrelor use, but the positive association that we detected was much weaker despite using a more liberal definition, high CSA burden (CAI $5/h) than that used by Meurin et al (AHI $ 15 and CAI $ 50% AHI). Of note, our criteria for strict CSA were identical to the criteria used for CSA in Meurin et al However, our findings were borderline significant (P = 0.052) when using strict CSA criteria.…”

Section: Discussionsupporting

confidence: 80%

“…We performed an additional subgroup analysis on patients with ACS as sleep-disordered breathing has previously been observed to be highly prevalent in patients with ACS, and ticagrelor is most commonly used in patients with ACS. 9 In this analysis, the relationship between ticagrelor and high CSA burden was significant both with and without adjusting for any AF history (Tables 8 and 9). Furthermore, the relationship between ticagrelor and strict CSA became significant in this subgroup.…”

Section: Discussionmentioning

confidence: 80%

“…5 There have been case reports and a small prospective study that have suggested an association between the initiation of the P2Y12 inhibitor, specifically ticagrelor, and CSA incidence. [6][7][8][9] However, there is conflicting data from a larger registry analysis that refutes any relationship between ticagrelor and CSA. 10 As ticagrelor has become more widely used given its benefits over other P2Y12 inhibitors in patients with acute coronary syndrome (ACS) and by extension in patients with CHD, it is important that such a relationship be clarified.…”

Section: Introductionmentioning

confidence: 99%

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Central Sleep Apnea in Patients with Coronary Heart Disease Taking P2Y12 Inhibitors

Tzeng,

Klein,

Roth

et al. 2023

Journal of Cardiovascular Pharmacology

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Central sleep apnea (CSA) is common in patients with heart failure. Recent studies link ticagrelor use with CSA. We aimed to evaluate CSA prevalence in patients with coronary heart disease (CHD) and whether ticagrelor use is associated with CSA. We reviewed consecutive patients with CHD who underwent a polysomnography (PSG) test over a 5-year period from three sleep centers. We sampled patients who were on ticagrelor or clopidogrel during a PSG test at a 1:4 ticagrelor:clopidogrel ratio. Patients with an active opioid prescription during PSG test were excluded. Age, left ventricle (LV) dysfunction, and P2Y12 inhibitor use were included in a multivariate logistic regression. A total of 135 patients were included with 26 on ticagrelor and 109 on clopidogrel (age 64.1 ± 11.4, 32% male). High CSA burden (12%) and strict CSA (4.4%) were more common in patients on ticagrelor than in those on clopidogrel (27% vs. 8.3% and 10.0% vs. 1.8%). Ticagrelor use (vs. clopidogrel) was associated with high CSA burden (OR 3.53, 95% CI 1.04-12.9, p=0.039) and trended towards significance for strict CSA (OR 6.32, 95% CI 1.03-51.4, p=0.052) when adjusting for age and LV dysfunction. In an additional analysis also adjusting for history of atrial fibrillation, ticagrelor use and strict CSA became significantly associated (OR 10.0, 95% CI 1.32-117, p=0.035). CSA was uncommon in patients with CHD undergoing sleep studies. Ticagrelor use (vs. clopidogrel) was associated with high CSA burden and trended toward significance for strict CSA.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

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Central Sleep Apnea in Patients with Coronary Heart Disease Taking P2Y12 Inhibitors

Tzeng,

Klein,

Roth

et al. 2023

Journal of Cardiovascular Pharmacology

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“…A previous study using the VigiBase database found 28 cases of sleep apnea in ADE reports associated with ticagrelor, and through a proportional imbalance analysis, sleep apnea was identified as a risk signal for ticagrelor (ROR = 4.16, 95% CI = 2.87–6.03) ( Revol et al, 2018 ). A single-center prospective clinical trial was conducted to assess the association between CSA hypoventilation syndrome (CSAHS) and ticagrelor administration; a high prevalence of CSA after ACS was found (22.3%), and a much higher incidence was found in patients treated with ticagrelor than in those who were not (30% vs. 7.3%), confirming the association between ticagrelor and CSA ( Meurin et al, 2021 ). As a result, the US FDA approved a new safety statement about CSA and Cheyne-Stokes respiration in September 2020 ( FDA, 2020 ).…”

Section: Discussionmentioning

confidence: 76%

A disproportionality analysis of FDA adverse event reporting system (FAERS) events for ticagrelor

Pan,

Wang,

Zheng

et al. 2024

Front. Pharmacol.

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Background:Ticagrelor is a commonly used antiplatelet agent, but due to the stringent criteria for trial population inclusion and the limited sample size, its safety profile has not been fully elucidated.Method:We utilized OpenVigil 2.1 to query the FDA Adverse Event Reporting System database and retrieved reports by the generic name “ticagrelor” published between 1 October 2010 and 31 March 2023. Adverse drug events (ADEs) were classified and described according to the preferred terms and system organ classes in the Medical Dictionary of Regulatory Activity. Proportional reporting ratio (PRR), reporting odds ratio (ROR) and Bayesian Confidence Propagation Neural Network (BCPNN) were used to detect signals.Results:The number of ADE reports with ticagrelor as the primary suspect drug was 12,909. The top three ADEs were dyspnea [1824 reports, ROR 7.34, PRR 6.45, information component (IC) 2.68], chest pain (458 reports, ROR 5.43, PRR 5.27, IC 2.39), and vascular stent thrombosis (406 reports, ROR 409.53, PRR 396.68, IC 8.02). The highest ROR, 630.24, was found for “vascular stent occlusion”. Cardiac arrest (137 reports, ROR 3.41, PRR 3.39, IC 1.75), atrial fibrillation (99 reports, ROR 2.05, PRR 2.04, IC 1.03), asphyxia (101 reports, ROR 23.60, PRR 23.43, IC 4.51), and rhabdomyolysis (57 reports, ROR 2.75, PRR 2.75, IC 1.45) were suspected new adverse events of ticagrelor.Conclusion:The FAERS database produced potential signals associated with ticagrelor that have not been recorded in the package inserts, such as cardiac arrest, atrial fibrillation, asphyxia, and rhabdomyolysis. Further clinical surveillance is needed to quantify and validate potential hazards associated with ticagrelor-related adverse events.

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Central Sleep Apnea: An Update of Current Treatment and the Role of Positive Pressure Devices

Matthes,

Javaheri,

Javaheri

et al. 2024

Curr Sleep Medicine Rep

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Central sleep apnea after acute coronary syndrome and association with ticagrelor use

Cited by 8 publications

References 22 publications

Central Sleep Apnea in Patients with Coronary Heart Disease Taking P2Y12 Inhibitors

Central Sleep Apnea in Patients with Coronary Heart Disease Taking P2Y12 Inhibitors

A disproportionality analysis of FDA adverse event reporting system (FAERS) events for ticagrelor

Central Sleep Apnea: An Update of Current Treatment and the Role of Positive Pressure Devices

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