Síndrome da Apneia-Hipopneia do Sono e Síndrome Coronária Aguda – Uma associação a não esquecer

Areias, Vanda; Romero, José R.; Cunha, Karl; Faria, Ricardo; Mimoso, Jorge; Gomes, Veloso; Brito, Ulisses

doi:10.1016/j.rppneu.2011.07.004

Cited by 19 publications

(8 citation statements)

References 22 publications

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“…Therefore, this value did not seem to be a determining factor in the diagnosis of SA in these patients. The limitations of ESS are known in cardiovascular patients and the existence of patients with severe SA without excessive sleepiness is controversial [ 41 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of SA in patients with CAD was higher than in normal population, as stated by numerous studies, and was in range or higher than in our study. The studies reported a wide range of prevalence, ranging from 26% to 66%, partially explained by the different value of AHI used to establish the diagnosis of SA in the different studies [ 3 , 5 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

“…LVH was defined as gender-neutral cutoff value for LVM indexed for height > 51 g/m 2.7 [ 40 , 41 ]. Relative wall thickness (RWT) was computed by the ratio of sum of IVST and LVPWT to LVEDD.…”

Section: Methodsmentioning

confidence: 99%

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The association of sleep disordered breathing with left ventricular remodeling in CAD patients: a cross-sectional study

Alonderis

Raškauskienė

Gelžinienė

et al. 2017

BMC Cardiovasc Disord

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BackgroundThere is still insufficient knowledge on the potential effect of mild to moderate sleep-disordered breathing (SDB) that is widely prevalent, often asymptomatic, and largely undiagnosed in patients with stable coronary artery disease (CAD). SDB affects 34% of men and 17% of women aged between 30 and 70. The objective of this study was to evaluate the association between SDB and left ventricular (LV) hypertrophy as well as structural remodeling in stable CAD patients.MethodsThe study was based on a cross-sectional design. Echocardiography and polysomnography was performed in 772 patients with CAD and with untreated sleep apnea. All study participants underwent testing by Epworth Sleepiness Scale questionnaire. Their mean age, NYHA and left ventricular ejection fraction were, respectively: 57 ± 9 years, 2.1 ± 0.5 and 51 ± 8%, and 76% were men. Sleep apnea (SA) was defined as an apnea-hypopnea-index (AHI) ≥5 events/h, and, non-SA, as an AHI <5.ResultsSleep apnea was present in 39% of patients, and a large fraction of those patients had no complaints on excessive daytime sleepiness. The patients with SA were older, with higher body mass and higher prevalence of hypertension. LV hypertrophy (LVH), defined by allometrically corrected (LV mass/height2.7) gender-independent criteria, was more common among the patients with SA than those without (86% vs. 74%, p < 0.001). The frequency of LVH by wall thickness criteria (interventricular septal thickness or posterior wall thickness ≥ 12 mm: 49% vs. 33%, p < 0.001) and concentric LVH (61% vs. 47%, p = 0.001) was higher in CAD patients with SA. The patients with SA had significantly higher values of both interventricular septal thickness and posterior wall thickness. Multiple logistic regression analysis showed that even mild sleep apnea was an independent predictor for LVH by wall thickness criteria and concentric LVH (OR = 1.5; 95% CI 1.04–2.2 and OR = 1.9; 1.3–2.9 respectively).ConclusionsWe concluded that unrecognized sleep apnea was highly prevalent among patients with stable CAD, and the majority of those patients did not report daytime sleepiness. Mild to moderate sleep apnea was associated with increased LV wall thickness, LV mass, and with higher prevalence of concentric LV hypertrophy independently of coexisting obesity, hypertension, diabetes mellitus or advancing age.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The association of sleep disordered breathing with left ventricular remodeling in CAD patients: a cross-sectional study

Alonderis

Raškauskienė

Gelžinienė

et al. 2017

BMC Cardiovasc Disord

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“…The limitations of ESS are known in CV patients and the existence of patients with severe SA without excessive sleepiness is controversial. 47 , 48 An independent association between CV morbidity and breathing disorders in sleep was reported even for patients with SA within the normal range of AHI (1–10 events/h). 26 Although it is not feasible to refer all patients with CAD for a polysomnographic study in a sleep laboratory, some form of screening for SDB is needed.…”

Section: Discussionmentioning

confidence: 98%

Prevalence and predictors of sleep apnea in patients with stable coronary artery disease: a cross-sectional study

Alonderis¹,

Varoneckas²,

Raškauskienė³

et al. 2017

TCRM

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BackgroundSleep apnea (SA) is increasingly recognized as being important in the prognosis of patients with coronary artery disease (CAD); however, symptoms of SA are not easily identified, and as many as 80% of sufferers remain undiagnosed.AimThis cross-sectional study investigated the prevalence and predictors of SA that may help to increase the awareness and diagnosis of SA in stable CAD patients.Materials and methodsPolysomnography was performed in 772 medically stable CAD patients with untreated SA recruited from the Clinic of Cardiovascular Rehabilitation. Patients were predominantly male (76%), median age was 58 years (32–81). All subjects completed the Epworth sleepiness scale (ESS). The frequency of all apneas and hypopneas associated with 3% oxygen desaturation is referred to as the apnea–hypopnea index (AHI). Mild-to-severe SA was defined as AHI ≥5/h, moderate-to-severe SA as AHI ≥15/h.ResultsAHI was within a range of values that was considered normal or only mildly elevated. The median AHI was 3.4 (interquartile range [IQR 1–9]), and 39% of patients had unrecognized mild-to-severe SA (moderate-to-severe in 14%), which was not higher than other known risk indicators for CAD such as hypertension and obesity (83% and 47%, respectively). These patients did not show sleepiness and the risk-related cut-off score for excessive daily sleepiness was lower than the official for ESS.ConclusionHypertension, age, male gender, obesity, ESS ≥6, and left ventricular ejection fraction ≤45% were the best predictors of mild-to-severe SA. While, male gender, age 50–70 years and, mainly, the presence of obesity but not hypertension were clinical predictors for moderate-to-severe SA. In addition, association between mild-to-severe SA and obesity was not evident in women. SA is prevalent comorbidity in the stable CAD patients, especially in its asymptomatic mild form. We suggest that SA should be considered in the secondary prevention protocols for CAD.

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“…Prior studies evaluated obstructive sleep apnea and reported rates of: 47%, 43.1%, 76%, and 63% respectively, 30–33 when using either the Berlin Questionnaire 30, 32 or portable systems. 31, 33 Van den Broecke et al performed a remotely conducted sleep study using a tele-monitoring system to measure CSR and PB. 34 …”

Section: Discussionmentioning

confidence: 99%

ECG‐derived Cheyne‐Stokes respiration and periodic breathing in healthy and hospitalized populations

Tinoco

Drew

et al. 2017

Noninvasive Electrocardiol

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Background Cheyne-Stokes respiration has been investigated primarily in outpatients with heart failure. In this study we compare Cheyne-Stokes respiration (CSR) and periodic breathing (PB) between healthy and cardiac groups. Methods We compared CSR and PB, measured during 24 hours of continuous 12-lead electrocardiographic (ECG) Holter recording, in a group of 90 hospitalized patients presenting to the emergency department with symptoms suggestive of acute coronary syndrome to a group of 100 healthy ambulatory participants. We also examined CSR and PB in the 90 patients presenting with acute coronary syndrome symptoms, divided into a group of 39 (43%) with confirmed acute coronary syndrome, and 51 (57%) with a cardiac diagnosis but non-acute coronary syndrome. SuperECG software was used to derive respiration and then calculate CSR and PB episodes from the ECG Holter data. Regression analyses were used to analyze the data. We hypothesized SuperECG software would differentiate between the groups by detecting less CSR and PB in the healthy group than the group of patients presenting to the emergency department with acute coronary syndrome symptoms. Results Hospitalized patients with suspected acute coronary syndrome had 7.3 times more CSR episodes and 1.6 times more PB episodes than healthy ambulatory participants. Patients with confirmed acute coronary syndrome had 6.0 times more CSR episodes and 1.3 times more PB episodes than cardiac non-acute coronary syndrome patients. Conclusion Continuous 12-lead ECG derived CSR and PB appear to differentiate between healthy participants and hospitalized patients.

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Síndrome da Apneia-Hipopneia do Sono e Síndrome Coronária Aguda – Uma associação a não esquecer

Abstract: In our study, we found a high prevalence of SAHS in patients who were admitted to the CCU with ACS (43.1%). These results support the need for SAHS screening in patients who are hospitalized with ACS. The SST may have a role in the screening of SAHS in this population.

Cited by 19 publications

References 22 publications

The association of sleep disordered breathing with left ventricular remodeling in CAD patients: a cross-sectional study

The association of sleep disordered breathing with left ventricular remodeling in CAD patients: a cross-sectional study

Prevalence and predictors of sleep apnea in patients with stable coronary artery disease: a cross-sectional study

ECG‐derived Cheyne‐Stokes respiration and periodic breathing in healthy and hospitalized populations

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