Sleep apnoea and cardiovascular outcomes after coronary artery bypass grafting

Abstract

ObjectivePatients with advanced coronary artery disease are referred for coronary artery bypass grafting (CABG) and it remains unknown if sleep apnoea is a risk marker. We evaluated the association between sleep apnoea and major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing non-emergent CABG.MethodsThis was a prospective cohort study conducted between November 2013 and December 2018. Patients from four public hospitals referred to a tertiary cardiac centre for non-emergent CABG were recruited for an overnight sleep study using a wrist-worn Watch-PAT 200 device prior to CABG.ResultsAmong the 1007 patients who completed the study, sleep apnoea (defined as apnoea-hypopnoea index ≥15 events per hour) was diagnosed in 513 patients (50.9%). Over a mean follow-up period of 2.1 years, 124 patients experienced the four-component MACCE (2-year cumulative incidence estimate, 11.3%). There was a total of 33 cardiac deaths (2.5%), 42 non-fatal myocardial infarctions (3.7%), 50 non-fatal strokes (4.9%) and 36 unplanned revascularisations (3.2%). The crude incidence of MACCE was higher in the sleep apnoea group than the non-sleep apnoea group (2-year estimate, 14.7% vs 7.8%; p=0.002). Sleep apnoea predicted the incidence of MACCE in unadjusted Cox regression analysis (HR 1.69; 95% CI 1.18 to 2.43), and remained statistically significant (adjusted HR 1.57; 95% CI 1.09 to 2.25), after adjustment for age, sex, body mass index, left ventricular ejection fraction, diabetes mellitus, hypertension, chronic kidney disease and excessive daytime sleepiness.ConclusionSleep apnoea is independently associated with increased MACCE in patients undergoing CABG.Trial registration numberNCT02701504

Concomitant Sleep Apnea and Diabetes Mellitus Are Independently Associated with Cardiovascular Events and Hospitalization for Heart Failure after Coronary Artery Bypass Grafting

“…Numerous studies have demonstrated the associations of sleep apnea with various short-and long-term complications after CABG, including new-onset atrial brillation, respiratory complications, hospital readmission, and major adverse cardiac and cerebrovascular events (MACCEs) [12][13][14][15]. These ndings were corroborated by the recently published results of the SABOT (Sleep Apnea and Bypass Operation) study, which revealed an association of sleep apnea with a 1.57-fold increase in the risk of developing MACCEs [16].…”

“…No previous study on the association between DM and CABG outcomes has reported the additional prognostic effect of sleep apnea [3][4][5][6][7][8]. Recently, two relatively large-scale studies demonstrated an independent association of sleep apnea with adverse cardiovascular events in patients undergoing CABG and major non-cardiac surgery [16,25]. The predictive effects of sleep apnea and DM for adverse cardiovascular events were reported to be additive in patients undergoing percutaneous coronary intervention [26].…”

“…The SABOT study was a prospective, observational study that aimed to evaluate the effect of sleep apnea on the cardiovascular outcomes of patients undergoing CABG. Details regarding the methodology, patient selection, and results of the SABOT study were recently published [16]. Brie y, patients aged 18-90 years who were scheduled to undergo non-emergent CABG were invited to participate in the study.…”

The importance of early diagnosis and treatment of obstructive sleep apnoea in patients with cardiovascular diseases

“…Therefore, it seems legitimate to conduct diagnostics in this group of patients, given the fact that the prognosis is worse if OSA is left untreated [24]. A recent study involving more than 1,000 patients with advanced coronary artery disease eligible for coronary artery bypass grafting (CABG) [25] also showed that moderate and severe OSA was common, occurring in 50.9% of individuals in this group of patients. The study also proved that in patients with coronary artery disease, OSA was an independent factor contributing to major cardiovascular events, including death.…”

Association of Sleep-Disordered Breathing With Cardiovascular Events and Death in patients With Ischemic Heart Disease: A systematic review and meta-analysis

“…Sixteen studies reported an increased Hazard ratio (HR) of MACCEs outcomes with SDB compared with controls in patients with myocardial ischemia, 12,13,16,18,19,20,21,22,23,24,25,26,27,28,29,30 with the combined HR of 1.66(95% CI 1.41-1.94, P< 0.0001) (Fig 2). Some evidence of statistical heterogeneity (Cochran Q = 23.00, p=0.08; I 2 = 35%) was found by pooled effect size, which might be in part attributable to 1 randomized controlled trial.…”