Obstructive sleep apnea is common among patients referred for coronary artery bypass grafting and can be diagnosed by portable monitoring

Abstract

2012Obstructive sleep apnea is common among patients referred for coronary artery bypass grafting and can be diagnosed by portable monitoring CORONARY ARTERY DISEASE, PHILADELPHIA, v. 23, n. 1, supl. 2, Part 3, pp. 31-38, JAN, 2012 http://www.producao.usp.br/handle/BDPI/32565 Downloaded from: Biblioteca Digital da Produção Intelectual -BDPI, Universidade de São Paulo Biblioteca Digital da Produção Intelectual -BDPI Outros departamentos -FM/Outros Comunicações em Eventos -FM/OutrosObstructive sleep apnea is common among patients referred for coronary artery bypass grafting and can be diagnosed by portable monitoring Background Obstructive sleep apnea (OSA) is common among patients with coronary artery disease. However, OSA remains largely under recognized. The lack of clinical suspicion and difficulties to access full polysomnography (PSG) are limiting factors. The aim of this study was to evaluate, among patients referred to coronary artery bypass grafting (CABG): (i) the prevalence of OSA, (ii) the association of OSA with clinical symptoms, (iii) the performance of overnight unattended portable monitoring (PM) as an alternative method for the diagnosis of OSA.Methods Consecutive patients referred for CABG were evaluated by standard physical evaluation and validated questionnaires (Berlin questionnaire and Epworth Sleepiness Scale) and underwent full PSG and PM (Stardust II). ResultsWe studied 70 consecutive patients (76% men), age 58 ± 7 years (mean ± SD), BMI [median (interquartile range)] 27.6 kg/m 2 (25.8-31.1). The prevalence of OSA (full PSG) using an apnea-hypopnea index of at least 5 events/h was 87%. Commonly used clinical traits for the screening of OSA such as the Epworth Sleepiness Scale and neck circumference had low sensitivities to detect OSA. In contrast, the Berlin questionnaire showed a good sensitivity (72%) to detect OSA. PM showed good sensitivity (92%) and specificity (67%) for the diagnosis of OSA.Conclusion OSA is strikingly common among patients referred for CABG. The Berlin questionnaire, but not symptom of excessive daytime sleepiness is a useful tool to screen OSA. PM is useful for the diagnosis of OSA and therefore is an attractive tool for widespread use among patients with coronary artery disease. IntroductionObstructive sleep apnea (OSA) is characterized by repeated episodes of partial or complete upper airway obstruction during sleep, and is associated with recurrent hypoxemia and arousals [1]. OSA is a public health problem with a prevalence ranging from 4 to 25% in the general population [2,3]. OSA is tightly linked to cardiovascular disease, and the prevalence of OSA is much higher in patients with established cardiovascular disease [4], such as hypertension [5,6], atrial fibrillation [7], and hypertrophic cardiomyopathy [8]. The estimated prevalence of OSA among patients with coronary artery disease (CAD) ranges from 40 to 45% [9][10][11][12][13]. Therefore, patients referred to coronary artery bypass grafting (CABG) may present a high prevalence of OSA. The recognition of...

Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

“…These studies were conducted in China, Brazil, Croatia, Turkey and the United States, thus reflecting a wide geographic sampling. 38,43,50,51,[59][60][61] Participants were those suspected of OSA and included mainly male, middle-aged and overweight or obese individuals. The overall results indicate that the ESS had a large number of false negative results limiting its utility for the diagnosis of OSA.…”

“…33 Our review identified nineteen studies that evaluated the performance of the Berlin Questionnaire against PSG in the identification of patients with OSA. [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52] The studies were conducted in a wide variety of geographic locations including Brazil, 38 Canada, 34,42 Greece, 37 Iran, 36 Korea, 40 Turkey, 43 and the United States. 41,44 Various patient populations were considered, including those in primary care clinics, sleep clinics, the veteran population, and patients with cardiac disease.…”

Effects of Gender on the Prevalence of Obstructive Sleep Apnea in Patients with Coronary Artery Disease

“…32 Yet, in real-world clinical practice, significantly more patients undergo coronary revascularization with percutaneous coronary intervention than coronary artery bypass surgery. Therefore, the excluded surgical candidates constituted a small proportion of CAD patients, and the OSA prevalence reported in this study should be very close to the actual prevalence among all patients presenting with symptomatic CAD.…”

Frequência de sonolência diurna e apneia obstrutiva do sono em pacientes submetidos à cirurgia cardíaca participantes de um Programa de Reabilitação Cardiorrespiratória

“…al., 2006;DANZI-SOARES et al, 2012;MUNGAN et al, 2013). Segundo a Academia Americana de Medicina do Sono (AASM) (2015), sua incidência é 2 a 3 vezes maior em pacientes com doenças cardiovasculares e sua prevalência gira em torno de 50% nesta população de doentes.…”