Impact of OSA on Cardiovascular Events After Coronary Artery Bypass Surgery

Uchôa, Carlos Henrique Gomes; Danzi-Soares, Naury de Jesus; Nunes, Flavia; Souza, Altay Alves Lino de; Nerbass, Flávia Baggio; Pedrosa, Rodrigo Pinto; César, Luiz Antonio Machado; Lorenzi-Filho, Geraldo; Drager, Luciano F.

doi:10.1378/chest.14-2152

Cited by 75 publications

(71 citation statements)

References 22 publications

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“…67 Those with sleep apnea had significantly higher major adverse cardiac or cerebrovascular events (35% vs 16%; P 5 .02) and new revascularization (19% vs 0%; P 5 .01). OSA was an independent factor associated with these events in the multivariate analysis.…”

Section: Obstructive Sleep Apnea and Rehabilitation Outcomementioning

confidence: 89%

“…OSA was an independent factor associated with these events in the multivariate analysis. 67 In a prospective observational study, patients with acute myocardial infarction (MI) and percutaneous coronary intervention underwent cardiovascular magnetic resonance to define salvaged myocardium and infarct size within 3 to 5 days and at 3 months after acute MI. Of the 56 patients included, 29 (52%) had SDB.…”

Section: Obstructive Sleep Apnea and Rehabilitation Outcomementioning

confidence: 99%

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Rehabilitation of Cardiovascular Disorders and Sleep Apnea

Jafari

2017

Sleep Medicine Clinics

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Section: Obstructive Sleep Apnea and Rehabilitation Outcomementioning

confidence: 89%

Section: Obstructive Sleep Apnea and Rehabilitation Outcomementioning

confidence: 99%

Rehabilitation of Cardiovascular Disorders and Sleep Apnea

Jafari

2017

Sleep Medicine Clinics

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“…Data in patients undergoing cardiac surgery are inconsistent with some results suggesting an association between OSA and postoperative complications and others not supporting this association 15,16 . A study of 67 prospectively recruited participants, assessed for OSA by polysomnography (PSG) showed no association between OSA and short term complications but reported that the OSA was independently associated with a higher rate of long-term cardiovascular events after CABG 15 . Another study by Foldvary-Schaefer et al recruited prospectively 107 patients and shown that OSA was not significantly associated with worse postoperative outcomes but authors commented that a small study sample could have influenced results 16 .…”

Section: Postoperative Outcomes In Patients With Osa Undergoing Cardimentioning

confidence: 93%

“…Only five out of 11 of the studies were prospective and used recognised sleep diagnostic (PSG or watch-PAT) to diagnose OSA [15][16][17][18][19] whilst the rest were either retrospective cohort assessments or used questionnaires to examine for high risk of OSA. Out of the five higher quality studies, two report no association between OSA and postoperative outcomes 15,16 , two report an association between OSA and POAF 17,19 and one with prolonged ventilation, tracheostomy, Intensive Care Unit and hospital stay 18 . The fact that the definitions of hypopnea have changed several times over the years, and that many of the studies included in the meta-analyses do not give specifics about their diagnostic procedures, may be a reason why studies reach different conclusions.…”

Section: Postoperative Outcomes In Patients With Osa Undergoing Cardimentioning

confidence: 99%

Obstructive sleep apnoea in patients undergoing cardiac surgery: Screening, postoperative outcomes and perioperative care

Mason¹

2018

J Cardiol and Cardiovasc Sciences

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Obstructive sleep apnoea (OSA) is common and high prevalence has been described amongst patients undergoing cardiac revascularisation surgery. An excess of postoperative complications has been reported in patients with untreated Obstructive Sleep Apnoea (OSA) following surgical procedures, including those undergoing cardiac surgery. This has led some clinicians towards pre-operative screening for OSA though the best screening methodology has not yet been established. Moreover, the effect of screening and of treatment for OSA on surgical outcomes remains unknown. Does current evidence justify screening and treating patients before they present for surgery? Is this leading to potential delay in surgery whilst awaiting sleep diagnostics and commencing the treatment? This review article will examine the available evidence base and endeavour to answer these questions and identify implications for future research. OSA and cardiovascular diseaseSleep Disordered Breathing is a term used to cover a range of breathing events encountered during sleep and includes obstructive sleep apnoea (OSA), central sleep apnoea, Cheyne-Stokes respiration and respiratory effort related arousals. OSA is the most common form of sleep disordered breathing. OSA is common 1 and the reported prevalence has increased in the last two decades 1 with the new data reported mainly in European population of adults 40-85 years old showing that at least mild OSA (apnoea-hypopnoea index ≥5) was present in 84% of men and 61% of women and at least moderate disease (apnoea-hypopnoea index ≥15) was present in 50% of men and 23 % of women 2 . OSA and cardiac disease share some common risk factors and in patients undergoing coronary artery bypass graft (CABG) procedures reported prevalence is high, ranging between 41 and 87% 3-5 .High proportions of patients may present for surgery without a previous diagnosis of OSA 6,7 and may be at risk of worse postoperative outcomes 8 . In patients with moderate to severe OSA syndrome Continuous Positive Airway Pressure (CPAP) is the conventional treatment with established clinical and cost effectiveness 9 but its effect on cardiovascular outcomes has not been confirmed. A recent, large, randomised controlled trial of adults with moderate to severe OSA and pre-existing cardiovascular disease showed that the use of CPAP had no significant effect on the prevention of recurrent serious cardiovascular events 10 . It is possible that patients with compliance exceeding 4h/night may

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“…Other postoperative adverse events such as reintubation, infection, pneumonia, myocardial infarction, 4,6,[8][9][10] were not included in our original protocol and failed to be recorded in our study as well. This limitation will push us to pursue more proper observation in our further study in the future.…”

mentioning

confidence: 99%