Nocturnal hypoxaemia after myocardial infarction: association with nocturnal myocardial ischaemia and arrhythmias.

Galatius-Jensen, Søren; Hansen, Jørgen Fischer; Rasmussen, Verner; Bildsøe, J; Therboe, M; Rosenberg, J

doi:10.1136/hrt.72.1.23

Cited by 50 publications

(22 citation statements)

References 25 publications

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“…The secondary outcomes of ventricular tachycardia occurrence and use of opiates were not different between the two groups, despite a higher prevalence of severe hypoxaemia in the group receiving air. These findings are consistent with previous studies that reported no relationship between hypoxia and ischaemia in coronary artery disease,36 37 but contrasted with another study that demonstrated a temporal relationship between nocturnal hypoxaemia and both ST-segment depression and arrhythmia after a MI 38…”

Section: Discussionsupporting

confidence: 92%

Routine use of oxygen in the treatment of myocardial infarction: systematic review

Wijesinghe

Perrin

Ranchord

et al. 2008

Heart

149

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Context: International guidelines recommend the routine use of oxygen therapy in the treatment of myocardial infarction (MI). Objective: To undertake a systematic review and metaanalysis of randomised placebo-controlled trials of oxygen therapy in MI. Data sources: Medline, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, EMBASE and CINHAL. Study selection: Randomised placebo-controlled trials of oxygen therapy in MI. Data extraction: The primary clinical outcome was mortality. Results: Two of 51 potential studies met the inclusion criteria. The one study with substantive clinical outcome data reported that in uncomplicated MI, high-flow oxygen was associated with a non-significant increased risk of death (risk ratio 2.9, 95% CI 0.8 to 10.3, p = 0.08) and a greater serum aspartate aminotransferase level (difference 19.2 IU/ml, 95% CI 0 to 38.4, p = 0.05) than room air. Conclusion: The limited evidence that does exist suggests that the routine use of high-flow oxygen in uncomplicated MI may result in a greater infarct size and possibly increase the risk of mortality.Oxygen has been used in the treatment of myocardial infarction (MI) and acute coronary syndromes for over 100 years.1 The rationale for its longstanding use is that it increases oxygen delivery to the ischaemic myocardium, thereby reducing the size of the MI and improving clinical outcomes. Evidence in support of this approach is primarily derived from animal models, in which the administration of 100% oxygen under normobaric or hyperbaric conditions during and/or after experimental coronary artery occlusion reduces the extent of myocardial necrosis in some, 2-6 but not all, studies. 7-10However, concern has been expressed that the findings from animal studies may have poor generalisability to the clinical situation in humans. 11Furthermore, there is evidence that the routine use of high-flow oxygen in uncomplicated MI may not improve clinical outcomes and may potentially cause harm.11 12 It is well established that arterial oxygen tension is a major determinant of coronary artery tone [13][14][15][16] and that hyperoxia may result in a marked reduction in coronary artery blood flow. [17][18][19][20][21][22][23][24] Other cardiovascular effects of high-flow oxygen therapy include a reduction in cardiac output and stroke volume and an increase in systemic vascular resistance and blood pressure in patients with a MI. [25][26][27][28][29][30][31] Despite this conflicting evidence, contemporaneous international guidelines 32 33 recommend the routine use of supplemental oxygen in the treatment of MI. As the treatment of MI is at the forefront of evidence-based medicine, we sought to review the clinical efficacy and safety of the use of oxygen in this clinical situation. A systematic review was undertaken to identify randomised placebo-controlled trials of oxygen therapy in the treatment of acute MI with the intention of estimating differences in clinical outcomes by meta-analysis. METHODS Search strategyTo i...

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Section: Discussionsupporting

confidence: 92%

Routine use of oxygen in the treatment of myocardial infarction: systematic review

Wijesinghe

Perrin

Ranchord

et al. 2008

Heart

149

View full text Add to dashboard Cite

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“…Nocturnal oxygen desaturation in the setting of an unstable coronary syndrome is a proven stimulus for ischaemia and lethal ventricular arrhythmia. 15 Our patients had chronic stable heart failure; none had an unstable coronary syndrome. A single study has reported that CRT reduces the frequency of ICD discharge.…”

Section: Discussionmentioning

confidence: 73%

Collateral circulation in aortic coarctation shown by 64 channel multislice computed tomography angiography

Leschka¹

2005

Heart

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Objective: To determine whether ventricular arrhythmia related to nocturnal hypoxaemia during CheyneStokes respiration (CSR) explains the observation that CSR is an independent marker of death in heart failure. Design: Prospective, observational study. Patients: 101 patients at high risk of clinical serious ventricular arrhythmia fitted with an implantable cardioverter-defibrillator (ICD). Measurements: Patients were studied at baseline for CSR during sleep. Arrhythmia requiring device discharge was used as a surrogate marker for possible sudden cardiac death. Results: 101 patients (42 with CSR) were followed up for a total of 620 months. Twenty six patients experienced 432 ICD discharge episodes. Twenty four (6%), 210 (49%), 125 (29%), and 73 (17%) episodes occurred across the time quartiles 0000-0559, 0600-1159, 1200-1759, and 1800-2359, respectively. Kaplan-Meier analysis showed a relative risk of 1 (95% confidence interval 0.5 to 2.2, p = 1) for device discharge in the CSR group. The average (SED) numbers of nocturnal ICD discharges per patient per month of follow up were 0.01 (0.01) and 0.04 (0.02) for patients with and without CSR, respectively (p = 0.6). Conclusion: These findings refute the proposition that CSR is related to heart failure death through nocturnal serious ventricular arrhythmia.

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“…Episodes of hypoxemia after surgery have been reported to occur mostly between postoperative nights 2 to 5. 58,59,65 These episodes may increase the risk of wound infection, cerebral dysfunction, and cardiac arrhythmias. 66 In an observational study at Mayo Clinic, it was found that the incidence of acute myocardial infarction peaked on day 3 after surgery.…”

Section: Sleep In America 2005mentioning

confidence: 99%

Obstructive Sleep Apnea Syndrome and Perioperative Complications: A Systematic Review of the Literature

Vasu

Grewal

Doghramji

2012

Journal of Clinical Sleep Medicine

212

147

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Obstructive sleep apnea syndrome (OSAS) is a common sleep related breathing disorder. Its prevalence is estimated to be between 2% and 25% in the general population. However, the prevalence of sleep apnea is much higher in patients undergoing elective surgery. Sedation and anesthesia have been shown to increase the upper airway collapsibility and therefore increasing the risk of having postoperative complications in these patients. Furthermore, the majority of patients with sleep apnea are undiagnosed and therefore are at risk during the perioperative period. It is important to identify these patients so that appropriate actions can be taken in a timely fashion. In this review article, we will discuss the epidemiology of sleep apnea in the surgical population. We will also discuss why these patients are at a higher risk of having postoperative complications, with the special emphasis on the role of anesthesia, opioids, sedation, and the phenomenon of REM sleep rebound. We will also review how to identify these patients preoperatively and the steps that can be taken for their perioperative management. OSAS has been shown to be associated with various healthrelated consequences, including increased rate of motor vehicle accidents, hypertension, diabetes mellitus, congestive heart failure, stroke, and all-cause mortality. [1][2][3][4][5][6][7][8][9] Recently, numerous studies have demonstrated that surgical patients with sleep apnea are at increased risk of having perioperative complications, including hypoxemia, pneumonia, diffi cult intubation, myocardial infarction, pulmonary embolism, atelectasis, cardiac arrhythmias, and unanticipated admission to the ICU. The majority of patients with OSA are undiagnosed upon admission and are at risk during the perioperative period, presumably due to their underlying sleep apnea. Therefore, it is very important to identify these patients preoperatively so that one can initiate appropriate perioperative measures. EpidemiologyOSAS is an extremely common sleep related breathing disorder, and its prevalence has been increasing throughout the world because of obesity and increasing age of the general population. Its prevalence is between 2% and 25% in the general population, depending upon how sleep apnea is defi ned. In an epidemiological study, Young et al. noted that the prevalence of sleep apnea, defi ned as apnea-hypopnea index (AHI) ≥ 5/h was 9% for women and 24% for men. 10 However, the prevalence of OSAS (defi ned as AHI ≥ 5/h and daytime sleepiness) was 2% in women and 4% in men. 10 The National Sleep Foundation (NSF) Sleep in America 2005Poll found that 1 in 4 Americans are at high risk of having sleep apnea based on the Berlin Questionnaire. 11 The prevalence of sleep apnea is much higher in surgical patients and depends on the type of surgery. In the bariatric surgery population, the prevalence of sleep apnea has been found to be > 70%. 12,13 It is the standard of care for these patients to get a formal sleep evaluation prior to undergoing the bariatric surgery. Howev...

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Nocturnal hypoxaemia after myocardial infarction: association with nocturnal myocardial ischaemia and arrhythmias.

Cited by 50 publications

References 25 publications

Routine use of oxygen in the treatment of myocardial infarction: systematic review

Routine use of oxygen in the treatment of myocardial infarction: systematic review

Collateral circulation in aortic coarctation shown by 64 channel multislice computed tomography angiography

Obstructive Sleep Apnea Syndrome and Perioperative Complications: A Systematic Review of the Literature

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