Obstructive sleep apnea increases the risk of cardiac events after percutaneous coronary intervention: a meta-analysis of prospective cohort studies

Qu, Hua; Guo, Ming; Zhang, Ying; Shi, Dazhuo

doi:10.1007/s11325-017-1503-8

Cited by 29 publications

(22 citation statements)

References 32 publications

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“…Systematic reviews: Nine studies were included [44][45][46][47][48][49][50][51][52]. The original studies included in the systemic reviews were of class I and II quality.…”

Section: Results Of Literature Searchmentioning

confidence: 99%

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

et al. 2020

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@ERSpublicationsEvidence suggests a bidirectional relationship between sleep and stroke. However, the pathophysiological base of the associations and the possibilities of improving prevention and outcome through sleep-related interventions require further evaluation.ABSTRACT Sleep disorders are highly prevalent in the general population and may be linked in a bidirectional fashion to stroke, which is one of the leading causes of morbidity and mortality.Four major scientific societies established a task force of experts in neurology, stroke, respiratory medicine, sleep medicine and methodology, to critically evaluate the evidence regarding potential links and the impact of therapy. 13 research questions were evaluated in a systematic literature search using a stepwise hierarchical approach: first, systematic reviews and meta-analyses; second, primary studies postdating the systematic reviews/meta-analyses. A total of 445 studies were evaluated and 88 included. Statements were generated regarding current evidence and clinical practice.Severe obstructive sleep apnoea (OSA) doubles the risk for incident stroke, especially in young to middle-aged patients. Continuous positive airway pressure (CPAP) may reduce stroke risk, especially in treatment-compliant patients. The prevalence of OSA is high in stroke patients and can be assessed by polygraphy. Severe OSA is a risk factor for recurrence of stroke and may be associated with stroke mortality, while CPAP may improve stroke outcome. It is not clear if insomnia increases stroke risk, while pharmacotherapy of insomnia may increase it. Periodic limb movements in sleep (PLMS), but not restless limb syndrome (RLS), may be associated with an increased risk of stroke. Preliminary data suggest a high frequency of post-stroke insomnia and RLS and their association with a less favourable stroke outcome, while treatment data are scarce.Overall, the evidence base is best for OSA relationship with stroke and supports active diagnosis and therapy. Research gaps remain especially regarding insomnia and RLS/PLMS relationships with stroke. This article has an editorial commentary: https://doi.

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“…Systematic reviews: Nine studies were included [44][45][46][47][48][49][50][51][52]. The original studies included in the systemic reviews were of class I and II quality.…”

Section: Results Of Literature Searchmentioning

confidence: 99%

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

et al. 2020

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“…Up to 66% of ACS patients have OSA and about 50% of patients with PCI suffer from OSA 3, 4, 5. Meta‐analysis demonstrated that cardiac death is 2‐fold higher in patients with OSA after successful PCI 4. The OSA patients also have more aggressive atherosclerotic disease and a greater risk of thrombotic complications, including stent thrombosis 22.…”

Section: Discussionmentioning

confidence: 99%

“…A prevalence of OSA up to 66% has been reported in the early phase of acute coronary syndrome (ACS) 3. And about 50% of patients with percutaneous coronary intervention (PCI) suffer from OSA 4, 5. Importantly, patients with OSA experience an increased risk of adverse outcomes after PCI 4, 5.…”

mentioning

confidence: 99%

“…And about 50% of patients with percutaneous coronary intervention (PCI) suffer from OSA 4, 5. Importantly, patients with OSA experience an increased risk of adverse outcomes after PCI 4, 5. Recent findings from meta‐analysis suggested that OSA appears to increase the risk of cardiac death, non‐fatal myocardial infarction (MI), and coronary revascularization in patients after PCI 4.…”

mentioning

confidence: 99%

“…Importantly, patients with OSA experience an increased risk of adverse outcomes after PCI 4, 5. Recent findings from meta‐analysis suggested that OSA appears to increase the risk of cardiac death, non‐fatal myocardial infarction (MI), and coronary revascularization in patients after PCI 4. Outcomes in ACS patients with moderate/severe OSA have shown to be worse compared with normal or mild OSA patients 6…”

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confidence: 99%

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Impact of Obstructive Sleep Apnea on Platelet Function Profiles in Patients With Acute Coronary Syndrome Taking Dual Antiplatelet Therapy

Gong

Xiao

Fan

et al. 2018

JAHA

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BackgroundObstructive sleep apnea (OSA) is a novel risk factor for acute coronary syndrome (ACS). Several studies have shown OSA to be associated with induced platelet reactivity. However, whether OSA have effects on platelet function profiles in ACS patients taking dual antiplatelet therapy remains unexplored.Methods and ResultsThis was a cross‐sectional observational study, in which ACS patients taking maintenance aspirin and clopidogrel therapy were included. OSA was defined as an apnea‐hypopnea index ≥15 events/hour. The inhibitory rate of arachidonic acid or adenosine diphosphate pathway were assessed with thrombelastography and defined patients with high residual on‐treatment platelet reactivity. Platelet indices were obtained from routine analysis of blood samples using an automated blood cell counter. A total of 127 ACS patients taking dual antiplatelet therapy were analyzed. Platelet volume indices, including mean platelet volume and platelet large cell ratio, were significantly increased in patients with OSA. Patients with OSA (n=68) had significantly lower inhibitory rate of adenosine diphosphate receptor pathway (P=0.028) compared with those without (n=59). After adjustment for potential confounders, patients with OSA were more likely to have high residual on‐treatment platelet reactivity after clopidogrel therapy (adjusted odds ratio: 3.25, 95% confidence interval: 1.19–8.87, P=0.021).ConclusionsIn ACS patients taking dual antiplatelet therapy, OSA is associated with an increased level of platelet volume indices, reduced clopidogrel‐induced antiplatelet effects and a greater prevalence of high residual on‐treatment platelet reactivity.

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International Consensus Statement on Obstructive Sleep Apnea

Chang

Goldberg

Alt

et al. 2023

Int Forum Allergy Rhinol

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Background: Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). Methods: Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidencebased review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. Results: The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. Conclusion:This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

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Obstructive sleep apnea increases the risk of cardiac events after percutaneous coronary intervention: a meta-analysis of prospective cohort studies

Abstract: In patients after PCI, OSA appears to increase the risk of cardiac death, non-fatal MI, and coronary revascularization.

Cited by 29 publications

References 32 publications

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

Impact of Obstructive Sleep Apnea on Platelet Function Profiles in Patients With Acute Coronary Syndrome Taking Dual Antiplatelet Therapy

International Consensus Statement on Obstructive Sleep Apnea

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