Nocturnal Oxygen Desaturation Correlates With the Severity of Coronary Atherosclerosis in Coronary Artery Disease

Hayashi, M; Fujimoto, Keisaku; Urushibata, Kazuhisa; Uchikawa, Shinichiro; Imamura, Hiroshi; Kubo, Keishi

doi:10.1378/chest.124.3.936

Cited by 85 publications

(64 citation statements)

References 21 publications

(24 reference statements)

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“…Our results showed that Gensini Score was paralleled with ODI, and OSAHS was an independent prognostic factor of CAD, which was in agreement with the results of Hayashi et al (23).…”

Section: Discussionsupporting

confidence: 93%

The effect of obstructive sleep apnea-hypopnea syndrome on acute myocardial infarction

Zhang¹,

Sun²,

Li³

et al. 2012

BLL

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Background and objectives: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is the most clinically common type of sleep-related breathing disorders. In this study, the effect of OSAHS on ST segment elevation myocardial infarction (STEMI) was investigated. Methods: Seventy-fi ve patients with STEMI were included in this study. The patients were divided into two groups: STEMI accompanied by OSAHS (O + ) group (33 patients) and STEMI without OSAHS (O -) group (42 patients). The differences of the clinical characteristics between the two groups were compared. The relationship between oxyhemoglobin desaturation index (ODI) and Gensini Score, and the relationships between OSAHS and clinical parameters were analyzed by a regression analysis. Results: AMI mainly occurred from 10 pm to 6 am in the O + group (45.5 %) and from 6 am to 2 pm in the O -group (52.3 %). The peak of serous creatine kinase (CK), high-sensitivity C-reactive protein (hs-CRP), N-terminal Pro-brain natriuretic peptide (NT-proBNP), and left ventricle end-diastolic volume index (LVEDVI) were significantly increased in the O + group compared to the O -group, while the left ventricular ejection fraction (LVEF) were signifi cantly decreased. The regression analysis showed that ODI was positively correlated with Gensini Score, while serous CK, hs-CRP, NT-proBNP, and OSAHS were independently associated with left ventricular insuffi ciency (LVI), and the incidence of LVI in O + group was 5.8 times as O -group. Conclusions: In STEMI patients with OSAHS, myocardial infarction mainly occurred from 10 pm to 6 am, and the incidence of LVI was signifi cantly higher than STEMI patients without OSAHS (Tab. 5, Fig. 2 Obstructive sleep apnea-hypopnea syndrome (OSAHS) is the most common type of sleep-related breathing disorders, which was caused by throat obstruction (1, 2). The syndrome associates somnolence and one or two of the following symptoms: severe snoring, nocturnal respiratory arrest, repeated nocturnal awakening, non-recuperative sleep, diurnal fatigue, and altered concentration (3 4). OSAHS may act to cause and promote the progression of hypertension, coronary artery disease (CAD), acute myocardial infarction (AMI) and cerebral vascular disease (1, 5). It is reported that its incidences in adult women is 2 %, and in adult men is 4 % (6). While in China, its incidence is about 3.62 % in people beyond 30 years, which means that there are more than 47 million of patients in China by now (7).Numerous studies showed that OSAHS is closely associated with the development and progression of CAD. The changes of hemodynamics, enhancement of the sympathetic activity, and oxidative stress that are caused by OSAHS can accelerate the process of artherosclerosis (8, 9). Peker et al (10) reported that the incidence of OSAHS is higher in the patients with CAD than in normal people, and OSAHS can raise the mortality of angiocardiopathy, while patients treated by continuous positive airway pressure (CPAP) can reverse this state. The results of Peker et al (10) al...

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“…Our results showed that Gensini Score was paralleled with ODI, and OSAHS was an independent prognostic factor of CAD, which was in agreement with the results of Hayashi et al (23).…”

Section: Discussionsupporting

confidence: 93%

The effect of obstructive sleep apnea-hypopnea syndrome on acute myocardial infarction

Zhang¹,

Sun²,

Li³

et al. 2012

BLL

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“…OSA is associated with coronary risk factors 26,27,28,29,30,31 and with known symptomatic coronary artery disease identified by angiography 32 . OSA was present in 9 of 10 patients with nocturnal angina pectoris 33 and in 37% of men and 30% of women with coronary artery disease 34 .…”

Section: Discussionmentioning

confidence: 99%

Obstructive sleep apnea, detected by the Berlin Questionnaire: an associated risk factor for coronary artery disease

et al. 2012

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Obstructive sleep apnea (OSA), a risk factor for coronary artery disease, remains under diagnosed. We investigated if OSA identified by the Berlin Questionnaire (BQ) is associated with the risk of coronary artery disease. Cases were patients referred for elective coronariography. The cases were classified with significant coronary lesions (stenosis > 50% in an epicardial coronary) or without significant coronary lesions. Controls were selected from a population-based sample. Positive BQ results were identified in 135 (41.2%) of 328 cases, in contrast with 151 (34.4%) of 439 control subjects (p = 0.03). In a multinomial logistic analysis, the risk for OSA identified by the BQ was independently associated with coronary artery disease in cases with lesions of at least 50% (OR = 1.53; 95%CI: 1.02-2.30; p = 0.04). The risk from OSA identified by the BQ was higher in younger subjects (40-59 years) (OR = 1.76; 95%CI: 1.05-2.97; p = 0.03) and in women (OR = 3.56; 95%CI: 1.64-7.72; p = 0.001). In conclusion, OSA identified by the BQ greatly increases the risks of coronary artery disease in patients having significant coronary artery lesions indicated by anangiogram, particularly in younger individuals and in women.

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“…The patients were divided into 2 groups according to their ODI values as follows: normal, <5 ODI events per hour and NOD, ≥5 ODI events per hour. 12,13,19 We also checked the amount of time during overnight sleep in which capillary pulse oxygen saturation (SpO 2 ) was <90%. We compared the change in mean heart rate between the baseline (5 minutes before desaturation) and during nocturnal desaturation in patients with NOD.…”

Section: Su Monitoring Data and Nodmentioning

confidence: 99%

“…7,19,29 Therefore, monitoring NOD in SU is a simple and reliable tool for screening for sleep apnea in patients with acute ischemic stroke. 7,12,13,[29][30][31] NOD secondary to sleepdisordered breathing could be a modifiable risk factor for stroke and other cardiovascular diseases.32,33 Lifestyle modification, such as weight-loss intervention, may help improve sleep-disordered breathing symptom and may possibly lead to stroke prevention. 23,34,35 In addition, long-term continuous positive airway pressure treatment, the representative treatment of sleep apnea, is considered to provide protection against stroke in patients with sleep-disordered breathing.…”

mentioning

confidence: 99%

“…10,11 Nocturnal oxygen desaturation (NOD) events can be evaluated using the oxygen desaturation index (ODI) based on oxygen saturation data obtained at the SU. 12,13 Using highresolution data, we compared the frequency of overnight NOD events between patients who were admitted for WUS and other patients with stroke. We hypothesized that nocturnal desaturation events in the SU are more common in patients with WUS.…”

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confidence: 99%

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Nocturnal Desaturation in the Stroke Unit Is Associated With Wake-Up Ischemic Stroke

Kim

Jeong

et al. 2016

Stroke

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Background and Purpose-Wake-up stroke (WUS) represents a quarter of all ischemic strokes and may be a specific subgroup. Nocturnal desaturation secondary to sleep-disordered breathing is an independent risk factor for stroke, but the association between nocturnal desaturation and WUS remains unclear. We investigated the relationship between nocturnal desaturation using oxygen desaturation index and WUS in patients with acute stroke in the stroke unit. Methods-A total of 298 patients admitted for acute ischemic stroke to the stroke unit between July 2013 and May 2015 were enrolled. The oxygen desaturation index was calculated using pulse oximetry data sampled every 1 minute during 9 hours on the first night (10:00 PM-7:00 AM) of the stroke unit admission, and nocturnal desaturation was defined as an oxygen desaturation index of 5 at least per hour. We compared the clinical characteristics and nocturnal desaturations between patients with and without WUS. Results-Among all patients (age, 67.7±12.6 years; male, 54.4%), 26.5% patients had WUS. The proportion of nocturnal desaturation was significantly greater in patients admitted with WUS (29.1% versus 12.3%, P=0.001). The age, sex, risk factors except for hyperlipidemia, stroke severity, and stroke mechanisms were similar between the 2 groups. After adjustment for covariates, it was found that nocturnal desaturation was significantly more common in the WUS group (odds ratio, 3.25; 95% confidence interval, 1.63-6.46). Conclusions-Nocturnal desaturation was more frequently observed in patients admitted with WUS during the first night in the stroke unit. This suggests that nocturnal desaturation is a possible modifiable risk factor for the occurrence of WUS. Baseline and Clinical AssessmentBaseline characteristics, including demographic data (age and sex) and vascular risk factors (hypertension, diabetes mellitus, hyperlipidemia, smoking history [current or past regular smoking], body mass index [BMI], and a past history of stroke/transient ischemic attack) were evaluated. Hypertension was defined as a history of antihypertensive treatment, a systolic blood pressure ≥140 mm Hg, or a diastolic blood pressure ≥90 mm Hg. 14 Hyperlipidemia was defined as a history of lipid-lowering medication, a serum total cholesterol level of >240 mg/dL, or a serum level of low-density lipoprotein cholesterol >160 mg/dL.15 Diabetes mellitus was defined as a hemoglobin A1C level of ≥6.5%, fasting blood glucose level of ≥7.0 mmol/L, nonfasting blood glucose level of ≥11.1 mmol/L, or the use of insulin or oral hypoglycemic drugs. 16 All of the patients were initially evaluated for stroke severity based on the National Institutes of Health Stroke Scale (NIHSS) neurological examination at SU admission. Ischemic strokes were categorized as large-artery atherosclerosis (LAA), small-vessel occlusion, cardioembolism, other determined, and undetermined based on the Trial of Org 10172 in Acute Stroke Treatment criteria. 17The ischemic lesion locations were divided into anterior circulation (ante...

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Nocturnal Oxygen Desaturation Correlates With the Severity of Coronary Atherosclerosis in Coronary Artery Disease

Cited by 85 publications

References 21 publications

The effect of obstructive sleep apnea-hypopnea syndrome on acute myocardial infarction

The effect of obstructive sleep apnea-hypopnea syndrome on acute myocardial infarction

Obstructive sleep apnea, detected by the Berlin Questionnaire: an associated risk factor for coronary artery disease

Nocturnal Desaturation in the Stroke Unit Is Associated With Wake-Up Ischemic Stroke

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