Impact of Sleep‐Disordered Breathing on Long‐Term Outcomes in Patients With Acute Coronary Syndrome Who Have Undergone Primary Percutaneous Coronary Intervention

Abstract

BackgroundSleep‐disordered breathing (SDB) has been recognized as an important risk factor for cardiovascular diseases; however, the impact of SDB on long‐term outcomes in patients with acute coronary syndrome has not been fully evaluated.Methods and ResultsWe performed overnight cardiorespiratory monitoring of 241 patients with acute coronary syndrome who were successfully treated with primary percutaneous coronary intervention between January 2005 and December 2008. The presence of SDB was defined as apnea–hypopnea index ≥5 events per hour. The end point was incidence of major adverse cardiocerebrovascular events, defined as a composite of all‐cause death, recurrence of acute coronary syndrome, nonfatal stroke, and hospital admission for congestive heart failure. Patients were followed for a median period of 5.6 years. Among the 241 patients who were finally enrolled, comorbidity of SDB with acute coronary syndrome was found in 126 patients (52.3%). The cumulative incidence of major adverse cardiocerebrovascular events was significantly higher in patients with SDB than in those without SDB (21.4% versus 7.8%, P=0.006). Multivariable analysis revealed that the presence of SDB was a significant predictor of major adverse cardiocerebrovascular events (hazard ratio 2.28, 95% CI 1.06–4.92; P=0.035).ConclusionsThe study's results showed that the presence of SDB among patients with acute coronary syndrome following primary percutaneous coronary intervention is associated with a higher incidence of major adverse cardiocerebrovascular events during long‐term follow‐up.

Clinical significance of obstructive sleep apnea in patients with acute coronary syndrome in relation to diabetes status

“…Several small observational studies have demonstrated the association between OSA and increased risk of adverse outcomes following ACS 12–14. Our study extends prior analysis by focusing on the role of OSA in a high-risk subset of patients with DM.…”

“…Obstructive sleep apnea (OSA) is an increasingly recognized chronic disorder in patients with ACS, with reported incidence of 36% to 63% across various ethnicities 8. Recent evidence indicates OSA initiates and exacerbates coronary atherosclerosis,9–11 and predicts adverse cardiovascular outcomes post-ACS in the long run 12–16. Also, studies have shown the potential interaction between OSA and DM in glycemic control and the development of chronic diabetic complications 17–20.…”

Obstructive sleep apnea and the risk of cardiovascular disease

“…Среди пациентов с ИБС, как правило, более высокий уровень смертности -у больных с острым коронарным синдромом. В исследовании, опубликованном T. Mazaki et al в 2016 г., коморбидность СОАС с острым коронарным синдромом была обнаружена у 52,3% больных [27]. Всем пациентам проводили первичное чрескожное коронарное вмешательство.…”

Do the blood pressure changes in association with continuous positive airway pressure compliance play an important role to improve cardiovascular outcomes?

“…Several studies have also reported that the presence of OSA can have a prognostic impact on patients with CVD. For instance, the co-existence of OSA with: stable coronary artery disease (CAD), acute coronary syndrome (ACS), acute myocardial infarction (MI) and HF, is associated with an increased risk of CV mortality and morbidity (9)(10)(11)(12)(13)(14).…”