Effects of moderate-to-severe obstructive sleep apnea on the clinical manifestations of plaque vulnerability and the progression of coronary atherosclerosis in patients with acute coronary syndrome

Nakashima, Hiroshi; Kurobe, Masayuki; Minami, Kazutoshi; Furudono, Shinnosuke; Uchida, Yuzou; Amenomori, Kentarou; Nunohiro, Tatsuya; Takeshita, Satoshi; Maemura, Koji

doi:10.1177/2048872614530865

Cited by 55 publications

(54 citation statements)

References 35 publications

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“…Morra et al reported a statistically significant inverse correlation between the AHI and LVEF [29]. Nakashima et al observed that in ACS patients with equivalent LVEF at baseline, after 21 days, the LVEF was significantly lower in patients with OSA vs. control subjects (52% vs. 59%; p < 0.02) [2,21].…”

Section: Left Ventricular Ejection Fraction (Lvef)mentioning

confidence: 98%

Prevalence of Undiagnosed Obstructive Sleep Apnea Among Patients Hospitalized for Cardiovascular Disease and Associated In-Hospital Outcomes: A Scoping Review

Suen

Wong

Ryan

et al. 2020

JCM

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Background: Obstructive sleep apnea (OSA) is associated with long-term cardiovascular morbidity and is highly prevalent in patients with cardiovascular disease (CVD). The objectives of this scoping review were to determine the prevalence of OSA inpatients hospitalized for CVD and to map the range of in-hospital outcomes associated with OSA. Methods: We searched MEDLINE(R), Embase, and Cochrane Databases for articles published from 1946–2018. We included studies involving non-surgical adults with OSA or at high risk of OSA who were hospitalized for CVD. The outcomes were considered as in-hospital if they were collected from admission up to 30 days post-discharge from hospital. Results: After the screening of 4642 articles, 26 studies were included for qualitative synthesis. Eligible studies included patients presenting with acute coronary syndromes (n = 19), congestive heart failure (n = 6), or any cardiovascular disease (n = 1). The pooled prevalence of OSA in cardiac inpatients was 48% (95% CI: 42–53). The in-hospital outcomes reported were mortality (n = 4), length of stay (n = 8), left ventricular ejection fraction (n = 8), peak troponin (n = 7), peak B-type natriuretic peptide (n = 4), and composite cardiovascular complications (n = 2). Conclusions: OSA is highly prevalent in the cardiac inpatient population. The outcomes reported included mortality, cardiac function, cardiac biomarkers, and resource utilization. There are significant knowledge gaps regarding the effect of treatment and OSA severity on these outcomes. The findings from this review serve to inform further areas of research on the management of OSA among patients with CVD.

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Section: Left Ventricular Ejection Fraction (Lvef)mentioning

confidence: 98%

Prevalence of Undiagnosed Obstructive Sleep Apnea Among Patients Hospitalized for Cardiovascular Disease and Associated In-Hospital Outcomes: A Scoping Review

Suen

Wong

Ryan

et al. 2020

JCM

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“…However, the groups were similar in terms of lowest oxygen saturation (medical management vs percutaneous coronary intervention, 85.7 Ϯ 5.9% vs 83.9 Ϯ 7.8%, P ϭ .16) and percentage of saturation Ͻ90% (medical management vs percutaneous coronary intervention, 4.4 Ϯ 13.3% vs 6.1 Ϯ 12.4%, P ϭ .47). After adjusting for sex and age, ODI, lowest S pO 2 , and S pO 2 were not associated with treatment with percutaneous coronary intervention ( Table 2). The percentage of moderate to severe OSA subjects in the percutaneous coronary intervention group tended to be higher than that in the medical management group (64.2% vs 52.3%, P ϭ .20) (Fig.…”

Section: Subject Characteristicsmentioning

confidence: 99%

“…1 For example, existing retrospective studies show that comorbid OSA confers increased risk of adverse outcomes after percutaneous coronary in-tervention. 2,3 Conversely, CPAP treatment reduces the occurrence of acute coronary syndrome in subjects with OSA 4 and decreases the risk of major adverse cardiac events (cardiac death, reinfarction, and target vessel revascularization) in those undergoing percutaneous coronary intervention. 3,5 In patients with cardiovascular disease, the prevalence of OSA ranges between 47 and 83%.…”

Section: Introductionmentioning

confidence: 99%

The Relationship Between Obstructive Sleep Apnea Hypopnea Syndrome and Inflammatory Markers and Quality of Life in Subjects With Acute Coronary Syndrome

Yuan

Wang

et al. 2016

Respir Care

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BACKGROUND: The objective of this work was to examine the relationship between obstructive sleep apnea (OSA) and inflammatory markers and quality of life in patients with acute coronary syndrome, especially undergoing percutaneous coronary intervention. METHODS: One hundred eighteen subjects were admitted with acute coronary syndrome over 1 y who had symptoms of OSA and positive polysomnography on admission. Of these subjects, 53 underwent primary percutaneous coronary intervention during their admission, and 65 had medical management. We then compared inflammatory markers by OSA status. We also assessed cardiac symptoms using the Seattle Angina Questionnaire and sleep symptoms using the Epworth Sleepiness Scale. RESULTS: Subjects in the percutaneous coronary intervention group had a higher oxygen desaturation index (ODI) (P ‫؍‬ .02) and apnea-hypopnea index (AHI) (P ‫؍‬ .048) compared with those in the medical management group. In percutaneous coronary intervention subjects, the moderate-severe OSA group (AHI > 15/h) had a higher hematocrit (P ‫؍‬ .047), homocysteine (P ‫؍‬ .01), and highsensitivity C-reactive protein (P ‫؍‬ .045) compared with those with no or mild OSA (AHI < 15/h). There was a significant correlation between high-sensitivity C-reactive protein and both AHI (r ‫؍‬ 0.46, P ‫؍‬ .001) and ODI (r ‫؍‬ 0.47, P < .001). Those with moderate-severe OSA had higher Epworth Sleepiness Scale (P ‫؍‬ .002), greater physical limitation (P ‫؍‬ .01), and lower treatment satisfaction and disease perception (P ‫؍‬ .007), as judged by subscales of the Seattle Angina Questionnaire, compared with those with no or mild OSA. Finally, subjects undergoing percutaneous coronary intervention with lower AHI (r ‫؍‬ 0.48, P < .001) and ODI (r ‫؍‬ 0.49, P < .001) reported higher treatment satisfaction. CONCLUSIONS: Subjects with acute coronary syndrome undergoing percutaneous coronary intervention who had moderate-severe OSA showed higher levels of inflammatory mediators and lower treatment satisfaction and disease perception. These factors may increase the risk of adverse sequelae by increasing the systemic inflammatory response.

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“…Accordingly, affected individuals are at risk of endothelial dysfunction and adverse cardiovascular (CV) outcomes . Ample evidence suggests that OSA is prevalent among patients presenting with ACS, in whom it acts as a negative prognosticator . In a multicenter study of 1311 patients undergoing percutaneous coronary intervention, a diagnosis of OSA independently predicted adverse CV events at a 2‐year follow‐up …”

Section: Introductionmentioning

confidence: 99%

Sleep study–guided multidisciplinary therapy (SGMT) for patients with acute coronary syndrome: Trial rationale and design

Chua

Koo

Kristanto

et al. 2018

Clinical Cardiology

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Obstructive sleep apnea (OSA) is an emerging risk marker for acute coronary syndrome (ACS). This randomized trial aims to determine the effects of sleep study-guided multidisciplinary therapy (SGMT) comprising overnight sleep study, continuous positive airway pressure, and behavioral therapy for OSA during the subacute phase of ACS. We hypothesize that SGMT will reduce (1) the plasma levels of N-terminal pro brain natriuretic peptide and suppression of tumorigenicity 2; (2) the estimated 10-year risk of cardiovascular mortality as measured by the European Systematic Coronary Risk Evaluation (SCORE) algorithm; and (3) the cardiovascular event rate during a 3-year follow-up, compared with standard therapy. In the SGMT trial, 180 patients presenting with ACS will be randomly assigned to SGMT (n = 90) and standard therapy (n = 90) groups. Both groups will receive guideline-mandated treatment for ACS. Those assigned to SGMT will additionally undergo a sleep study and, if OSA is diagnosed, attend a multidisciplinary OSA clinic where they will receive personalized treatment including continuous positive airway pressure and behavioral/lifestyle counseling. The primary endpoint is the plasma N-terminal pro brain natriuretic peptide concentration at 7-month follow-up. This report presents the baseline characteristics of 117 patients (SGMT group: n =54; standard therapy group: n =63) who had been enrolled into the study as of August 31, 2017. The results of this trial will help us to understand whether active OSA diagnosis and treatment will improve the physiologic and clinical cardiovascular outcomes of this group of patients.

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Effects of moderate-to-severe obstructive sleep apnea on the clinical manifestations of plaque vulnerability and the progression of coronary atherosclerosis in patients with acute coronary syndrome

Abstract: Moderate-to-severe OSA increased the risk of ACS and the incidence of PCI for progressive lesions. Increased plaque vulnerability might be related to these clinical manifestations.

Cited by 55 publications

References 35 publications

Prevalence of Undiagnosed Obstructive Sleep Apnea Among Patients Hospitalized for Cardiovascular Disease and Associated In-Hospital Outcomes: A Scoping Review

Prevalence of Undiagnosed Obstructive Sleep Apnea Among Patients Hospitalized for Cardiovascular Disease and Associated In-Hospital Outcomes: A Scoping Review

The Relationship Between Obstructive Sleep Apnea Hypopnea Syndrome and Inflammatory Markers and Quality of Life in Subjects With Acute Coronary Syndrome

Sleep study–guided multidisciplinary therapy (SGMT) for patients with acute coronary syndrome: Trial rationale and design

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