Influence of obstructive sleep apnoea in coronary artery disease: A 10-year follow-up

Hagenah, G; Gueven, Elif; Andreas, Stefan

doi:10.1016/j.rmed.2005.04.009

Cited by 25 publications

(12 citation statements)

References 9 publications

(14 reference statements)

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“…SDB was independently and significantly associated with a composite end-point of death, cardiovascular events and myocardial infarction. HAGENAH et al [24], however, failed to confirm these observations. They conducted a 10-yr follow-up on 50 patients with cardiovascular disease, all .70 yrs of age, of whom half had an AHI .10 events?h -1 .…”

Section: Mortality In Patients With Pre-existing Cardiovascular Morbimentioning

confidence: 89%

Mortality in sleep apnoea syndrome: a review of the evidence

Lavie¹

2007

European Respiratory Review

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Sleep apnoea syndrome is associated with cardiovascular morbidity, but it is less clear if it is also associated with increased mortality.Studies investigating mortality in sleep apnoea have 1) compared mortality rates of patients with different levels of severity of the syndrome relying on sleep laboratory populations, 2) compared treated and untreated patients, 3) examined the effect of co-existing cardiovascular diseases on survival and 4) investigated the effect of sleep-disordered breathing on mortality in the elderly.In spite of methodological limitations, the accumulated data generally support an increased risk of mortality in patients with severe sleep apnoea in comparison with mild or no sleep apnoea, and indicate that efficient treatment decreases mortality. Surprisingly, several studies have shown that the highest risk of mortality in sleep apnoea occurs in patients younger than 50 yrs of age, that risk tends to decline with age and that the occurrence of disordered breathing in sleep in the elderly does not affect mortality. It is as yet unclear if this finding represents a selection bias, differences in apnoea severity or in compliance with treatment between young and old patients, or an adaptation to the syndrome with age.There is conflicting evidence as to whether the occurrence of sleep apnoea in patients with existing cardiovascular diseases increases the risk of mortality beyond that associated with the cardiovascular diseases themselves.

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Section: Mortality In Patients With Pre-existing Cardiovascular Morbimentioning

confidence: 89%

Mortality in sleep apnoea syndrome: a review of the evidence

Lavie¹

2007

European Respiratory Review

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“…Peker and colleagues 12 reported an increase in mortality rates among 62 patients with coronary artery disease during 5 years of follow-up. On the other hand, Hagenah and colleagues 14 reported no increase in death rates related to sleep apnea among 50 patients with coronary artery disease. We have previously reported an increased risk of the combined end point of death, myocardial infarction, stroke, and transient ischemic attack at an oxygen desaturation index of 5 or more.…”

Section: Clinical Perspective P 960mentioning

confidence: 95%

Increased Risk of Stroke in Patients With Coronary Artery Disease and Sleep Apnea

et al. 2008

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Background-The effect of sleep apnea on mortality and cardiovascular morbidity is mainly unknown. We aimed to study whether sleep apnea is related to stroke, death, or myocardial infarction in patients with symptomatic coronary artery disease. Methods and Results-A total of 392 men and women with coronary artery disease referred for coronary angiography were examined by use of overnight sleep apnea recordings. Sleep apnea, defined as an apnea-hypopnea index Ն5, was recorded in 54% of the patients. All patients were followed up prospectively for 10 years, and no one was lost to follow-up. Stroke occurred in 47 (12%) of 392 patients during follow-up. Sleep apnea was associated with an increased risk of stroke, with an adjusted hazard ratio of 2.89 (95% confidence interval 1.37 to 6.09, Pϭ0.005), independent of age, body mass index, left ventricular function, diabetes mellitus, gender, intervention, hypertension, atrial fibrillation, a previous stroke or transient ischemic attack, and smoking. Patients with an apnea-hypopnea index of 5 to 15 and patients with an apnea-hypopnea index Ն15 had a 2.44 (95% confidence interval 1.08 to 5.52) and 3.56 (95% confidence interval 1.56 to 8.16) times increased risk of stroke, respectively, than patients without sleep apnea, independent of confounders (P for trendϭ0.011). Death and myocardial infarction were not related to sleep apnea. Intervention in the form of coronary artery bypass grafting or percutaneous coronary intervention was related to a longer survival but did not affect the incidence of stroke. Conclusions-Sleep apnea is significantly associated with the risk of stroke among patients with coronary artery disease who are being evaluated for coronary intervention.

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“…Moreover, the frequency of nocturnal desaturations correlated with the extent of coronary lesions and explained 13.4% of their variance, suggesting a pathogenetic role of OSAS in coronary atherosclerosis [120]. Some studies, however, did not confirm that OSAS worsened the prognosis of patients with CAD, as 10-yr survival did not differ between apnoeic and nonapnoeic subjects in a small series of 50 coronary patients [121].…”

Section: Coronary Artery Diseasementioning

confidence: 98%

Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities

Mr²

2006

European Respiratory Journal

760

471

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Considerable evidence is available in support of an independent association between obstructive sleep apnoea syndrome (OSAS) and cardiovascular disease, which is particularly strong for systemic arterial hypertension and growing for ischaemic heart disease, stroke, heart failure, atrial fibrillation and cardiac sudden death.The pathogenesis of cardiovascular disease in OSAS is not completely understood but likely to be multifactorial, involving a diverse range of mechanisms including sympathetic nervous system overactivity, selective activation of inflammatory molecular pathways, endothelial dysfunction, abnormal coagulation and metabolic dysregulation, the latter particularly involving insulin resistance and disordered lipid metabolism.The present report, which arose out of a European Union Cooperation in the field of Scientific and Technical Research (COST) action on OSAS (COST B26), reviews the current evidence for an independent association and proposes research priorities to identify the underlying mechanisms involved, with a view to identifying novel therapeutic strategies.Large-scale collaborative studies of carefully defined patient populations with obstructive sleep apnoea syndrome, adequately controlled for potential confounders, are needed. Such studies carry the prospect of evaluating potential interactions between different basic mechanisms operating in obstructive sleep apnoea syndrome and cardiovascular disease, and interactions with other related disorders, such as obesity, diabetes and dyslipidaemia. Furthermore, translational studies involving cell culture and animal models linked to studies of obstructive sleep apnoea syndrome patients are necessary to integrate basic mechanisms with the clinical disorder.

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Influence of obstructive sleep apnoea in coronary artery disease: A 10-year follow-up

Cited by 25 publications

References 9 publications

Mortality in sleep apnoea syndrome: a review of the evidence

Mortality in sleep apnoea syndrome: a review of the evidence

Increased Risk of Stroke in Patients With Coronary Artery Disease and Sleep Apnea

Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities

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