Obstructive sleep apnea and acute myocardial infarction severity: ischemic preconditioning?

Shah, Neomi; Redline, Susan; Yaggi, H. Klar; Wu, Richard; Zhao, Can; Ostfeld, Robert J.; Menegus, Mark; Tracy, Daniel; Brush, Elizabeth; Appel, W. David; Kaplan, Robert C.

doi:10.1007/s11325-012-0770-7

Cited by 134 publications

(82 citation statements)

References 20 publications

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“…A potential cardioprotective role of intermittent ischemia from recurrent episodes of apneas during MI via preconditioning has been described 34. Although reduced myocardial injury verified by cardiac enzyme levels after MI in patients with OSA has been reported, untreated OSA may increase the risk of MI and recurrence of MI 4.…”

Section: Discussionmentioning

confidence: 99%

Nocturnal Hypoxemia Due to Obstructive Sleep Apnea Is an Independent Predictor of Poor Prognosis After Myocardial Infarction

Xie

Kuniyoshi

Covassin

et al. 2016

JAHA

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BackgroundObstructive sleep apnea (OSA) is an important risk factor for the development of cardiovascular diseases including myocardial infarction (MI). The aim of this study was to investigate the effects of OSA on prognosis after MI, and to determine which specific measures of OSA severity best predicted outcomes.Methods and ResultsWe performed a prospective study, in which 112 patients without a prior diagnosis of sleep apnea underwent comprehensive polysomnography within a median of 7 days after MI. Patients were followed up at 6‐monthly intervals (±2 weeks) for a total of 48 months. Patients classified with central apnea (n=6) or those using continuous positive airway pressure (n=8) after polysomnography were excluded from analyses. The primary end point was major adverse cardiac events, including death from any cause, recurrent MI, unstable angina, heart failure, stroke, and significant arrhythmic events. Forty of 98 patients (41%) had OSA (apnea‐hypopnea index ≥15 events/h). OSA patients had higher major adverse cardiac event rates when compared to those without OSA (47.5% versus 24.1%; χ2=5.41, P=0.020). In a multivariate model that adjusted for clinically relevant variables including age, left ventricular ejection fraction, diabetes mellitus, oxygen desaturation index, and arousal index, significant hypoxemia, as defined by nocturnal nadir oxygen saturation ≤85%, was an independent risk factor for major adverse cardiac events (hazard ratio=6.05, P=0.004) in follow‐up 15 months after baseline.ConclusionsNocturnal hypoxemia in OSA is an important predictor of poor prognosis for patients after MI. These findings suggest that routine use of low‐cost nocturnal oximetry may be an economical and practical approach to stratify risk in post‐MI patients.

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Section: Discussionmentioning

confidence: 99%

Nocturnal Hypoxemia Due to Obstructive Sleep Apnea Is an Independent Predictor of Poor Prognosis After Myocardial Infarction

Xie

Kuniyoshi

Covassin

et al. 2016

JAHA

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“…1-5 Up to 65% of patients who seek medical attention for a cardiovascular event are diagnosed with OSA. 1 There is a need to study OSA's ability to predict cardiovascular events; some cohort studies, following apneic patients, have identified a high number of fatal and non-fatal cardiovascular outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…1 Results suggest that intermittent hypoxia could work as a protection factor for ischemic events, a phenomenon that has been observed in apneic individuals who develop a cardiac lesion that is less severe than those of patients with no OSA after a MI. 5 Considering the prevalence of OSA, as well as the importance of cardiovascular diseases, the objective of the present systematic review of the literature was to verify the association between OSA and MI.…”

Section: Introductionmentioning

confidence: 99%

Association between Obstructive Sleep Apnea and Myocardial Infarction: A Systematic Review

Porto¹,

Sakamoto²,

Salles³

2017

Arquivos Brasileiros De Cardiologia

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Obstructive sleep apnea (OSA) has been associated to cardiovascular risk factors. However, the association between OSA and cardiovascular disease is still controversial. The objective of the present study was to verify the association between OSA and myocardial infarction (MI). This is a systematic review of the literature performed through electronic data sources MEDLINE/PubMed, PubMed Central, Web of Science and BVS -Biblioteca Virtual em Saúde (Virtual Health Library). The descriptors used were: 'obstructive sleep apnea' AND 'polysomnography' AND 'myocardial infarction' AND 'adults NOT 'treatment.' The present work analysed three prospective studies, selected from 142 articles. The studies followed a total sample of 5,067 OSA patients, mostly composed by male participants. All patients underwent night polysomnography, and all studies found an association between OSA and fatal and non-fatal cardiovascular outcomes. Thus, we were able to observe that 644 (12.7%) of the 5,067 patients suffered MI or stroke, or required a revascularization procedure, and 25.6% of these cardiovascular events were fatal. MI was responsible for 29.5% of all 644 analysed outcomes. There is an association between OSA and MI, in male patients, and apnea and hypopnea index (AHI) are the most reliable markers.

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“…21 This is probably because elderly patients, who have survived the long-standing hypoxia caused by OSA, become preconditioned for subsequent hypoxia better than young patients. 22 Similarly, in the case of chronic diseases, such as diabetes, hypertension, and dyslipidemia, people with long-term illnesses may be more resistant to OSA than those without these illnesses. 13 The most significant weakness of this study is that the adequacy of the diagnosis and the severity of disease could not be demonstrated.…”

Section: Discussionmentioning

confidence: 99%

Uvulopalatopharyngoplasty reduces the incidence of depression caused by obstructive sleep apnea

et al. 2018

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Objective To investigate the increase in the incidence of depression in patients with obstructive sleep apnea (OSA) and its preventability by uvulopalatopharyngoplasty (UPPP). Methods In this retrospective cohort study, data from the Korea National Health Insurance Corporation were analyzed. A total of 160,840 participants (age ≥ 20 years) who were newly diagnosed with OSA between 2007 and 2014 were included. The participants were classified into a group that underwent UPPP (UPPP group, n = 19,773) and a group that did not undergo surgical treatment (no surgery group, n = 141,067). Propensity score matching by age and sex was used to select the control group of 804,200 subjects. The mean follow‐up duration was 4.6 ± 2.3 years. The primary endpoint was newly diagnosed depression. Results The incidence of depression was higher in patients with OSA than in controls (hazard ratio [HR]: 1.678, 95% confidence interval [CI]: 1.650–1.706). The UPPP group was still at a higher risk of depression than was the control group (HR: 1.535, 95% CI: 1.463–1.610), but the HR was statistically lower than that in the no surgery group (HR: 1.694, 95% CI: 1.665–1.724). Conclusion OSA increases the incidence of depression, which may be prevented to some extent by UPPP. Level of Evidence 2b Laryngoscope, 129:1005–1009, 2019

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Obstructive sleep apnea and acute myocardial infarction severity: ischemic preconditioning?

Abstract: Our study demonstrates that patients with OSA have less severe cardiac injury during an acute non-fatal MI when compared to patients without OSA. This may suggest a cardioprotective role of sleep apnea during acute MI via ischemic preconditioning.

Cited by 134 publications

References 20 publications

Nocturnal Hypoxemia Due to Obstructive Sleep Apnea Is an Independent Predictor of Poor Prognosis After Myocardial Infarction

Nocturnal Hypoxemia Due to Obstructive Sleep Apnea Is an Independent Predictor of Poor Prognosis After Myocardial Infarction

Association between Obstructive Sleep Apnea and Myocardial Infarction: A Systematic Review

Uvulopalatopharyngoplasty reduces the incidence of depression caused by obstructive sleep apnea

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