Sleep-Disordered Breathing and Coronary Artery Disease

Arzt, Michael; Hetzenecker, Andrea; Steiner, SS; Büchner, Stefan

doi:10.1016/j.cjca.2015.03.032

Cited by 45 publications

(38 citation statements)

References 87 publications

(80 reference statements)

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“…Emerging evidence has demonstrated a close relationship between OSA and CAD [ 4 , 5 , 20 ]. Also, prior reports have shown that OSA-mediated chronic intermittent hypoxia (CIH), triggered by repetitive episodes of apneas and hypopneas, exacerbates metabolic dysfunction including insulin resistance and nonalcoholic fatty liver disease [ 10 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Obstructive sleep apnea (OSA) is an increasingly recognized chronic disorder in adults [ 1 , 2 ]. Recent evidence indicates OSA is closely related to the incidence and progression of coronary artery disease (CAD), and the prevalence of OSA is high (38% to 65%) in CAD patients [ 3 , 4 ]. Prior reports and our study have shown that OSA was associated with an increased risk of recurrent cardiovascular events in patients with CAD and/or undergoing PCI [ 5 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Association of C1q/TNF-Related Protein-9 (CTRP9) Level with Obstructive Sleep Apnea in Patients with Coronary Artery Disease

Jia

et al. 2020

Mediators of Inflammation

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Background. Obstructive sleep apnea (OSA) is closely related to the incidence and progression of coronary artery disease (CAD), and the mechanisms linking OSA and CAD are multifactorial. C1q/TNF-related protein-9 (CTRP9) is a novel adipokine that protects the heart against ischemic injury and ameliorates cardiac remodeling. We aimed to ascertain the clinical relevance of CTRP9 with OSA prevalence in patients with CAD. Methods. From August 2016 to March 2019, consecutive eligible patients with CAD (n=154; angina pectoris, n=88; acute myocardial infarction [AMI], n=66) underwent cardiorespiratory polygraphy. OSA was defined as an apnea-hypopnea index (AHI) ≥15 events·h−1. Plasma CTRP9 concentrations were measured by ELISA method. Results. Moderate/severe OSA was present in 89 patients (57.8%). CTRP9 levels were significantly decreased in the moderate/severe OSA group than in the no/mild OSA group (4.7 [4.1-5.2] ng/mL vs. 4.9 [4.4-6.0] ng/mL, P=0.003). The difference between groups was only observed in patients with AMI (3.0 [2.3-4.9] vs. 4.5 [3.2-7.9], P=0.009). Correlation analysis showed that CTRP9 levels were negatively correlated with AHI (r=−0.238, P=0.003) and oxygen desaturation index (r=−0.234, P=0.004) and positively correlated with left ventricular ejection fraction (r=0.251, P=0.004) in all subjects. Multivariate analysis showed that male gender (OR 3.099, 95% CI 1.029-9.330, P=0.044), BMI (OR 1.148, 95% CI 1.040-1.268, P=0.006), and CTRP9 levels (OR 0.726, 95% CI 0.592-0.890, P=0.002) were independently associated with the prevalence of moderate/severe OSA. Conclusions. Plasma CTRP9 levels were independently related to the prevalence of moderate/severe OSA in patients with CAD, suggesting that CTRP9 might play a role in the pathogenesis of CAD exacerbated by OSA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of C1q/TNF-Related Protein-9 (CTRP9) Level with Obstructive Sleep Apnea in Patients with Coronary Artery Disease

Jia

et al. 2020

Mediators of Inflammation

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“…SRBD are known to be associated with heart disease, eg, coronary artery disease, heart failure, and atrial fibrillation, 12 – 14 but less is known about their prevalence in valve disease. Similar to our findings, Prinz et al reported a prevalence of 71% of SRBD with a median AHI of 23 events/hour in severe aortic valve stenosis.…”

Section: Discussionmentioning

confidence: 99%

Severe aortic valve stenosis in the elderly: high prevalence of sleep-related breathing disorders

Keymel¹,

Hellhammer²,

Zeus³

et al. 2015

CIA

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BackgroundAortic valve stenosis is common in the elderly, with a prevalence of nearly 3% in patients aged 75 years or older. Despite the fact that sleep-related breathing disorders (SRBD) are thought to be associated with cardiac disease, little is known about their prevalence in this patient cohort. The purpose of this study was to evaluate the prevalence of SRBD in older patients with aortic valve stenosis admitted for transcatheter aortic valve implantation.MethodsForty-eight consecutive patients (mean age 81±6 years; 37.5% male) with symptomatic aortic valve stenosis and considered for transcatheter aortic valve replacement were screened for SRBD. Sleep studies were performed by in-hospital unattended cardiorespiratory polygraphy measuring nasal air flow, chest and abdominal efforts, as well as oxygen saturation and body position. The patients were divided in subgroups dependent on the documented apnea–hypopnea index (AHI; no SRBD was defined as an AHI of <5 events/hour; mild SRBD as AHI 5–15 events/hour, and moderate to severe SRBD as AHI ≥15 events/hour).ResultsThirty-seven patients (77%) had SRBD defined as an AHI of ≥5 events/hour. Eleven patients had an unremarkable investigation, with AHI <5 events/hour (mean 3.0±1.3 events/hour). Among patients with sleep apnea, 19 patients had mild SRBD, with an AHI of 5–15 events/hour (mean 9.9±3.4 events/hour) and 18 patients had moderate to severe SRBD (mean 26.6±11.3 events/hour). Mainly, obstructive apneas were found. Subgroups were not different regarding EuroSCORE (European System for Cardiac Operative Risk Evaluation) or aortic valve area. Also, no correlations were found between AHI and the additive or logistic EuroSCORE or aortic valve area. Significant correlations were found for AHI and N-terminal of the prohormone brain natriuretic peptide (r=0.53; P=0.003) and for AHI and glomerular filtration rate (r=−0.39; P=0.007).ConclusionSRBD is common in elderly patients with symptomatic aortic valve stenosis admitted for transcatheter aortic valve replacement. Interestingly, this finding is not reflected by the currently used risk scores. Further randomized studies are needed to evaluate the clinical significance of concomitant SRBD in the management of severe aortic stenosis.

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“…43 Finally, sleep-disordered breathing is an emerging risk factor for coronary artery disease and subsequent heart failure, and the effectiveness of CPAP on cardiac outcomes is being actively investigated. 44 In summary, sleep appears to have a protective effect on cardiac disease. Sleepiness from sleep deficiency appears to be a risk factor for dysrhythmias.…”

Section: Cardiac Diseasementioning

confidence: 99%

Emergency Sleep Medicine

Guay¹,

Ellenbogen

2017

Semin Neurol

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Sleep is a tranquil process that contributes substantially to our overall health and well-being. Yet sleep creates certain vulnerabilities. These sometimes require urgent management decisions for prehospital emergency medical services and on-call medical providers alike. Some of these emergencies may be directly due to sleep itself, whereas others may result from sleep disorders or a lack of sleep. And then some medical emergencies may occur during sleep by chance. Yet for some of these emergencies, sleep does not necessarily play a benign role. Sleep can mask the emergency—causing a delay in detection, confusion in the diagnosis, or even impede treatment. Finally, some disorders will mimic sleep and thus elude detection. Understanding these core principles will enable medical practitioners to optimize care for patients in emergency situations.

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Sleep-Disordered Breathing and Coronary Artery Disease

Cited by 45 publications

References 87 publications

Association of C1q/TNF-Related Protein-9 (CTRP9) Level with Obstructive Sleep Apnea in Patients with Coronary Artery Disease

Association of C1q/TNF-Related Protein-9 (CTRP9) Level with Obstructive Sleep Apnea in Patients with Coronary Artery Disease

Severe aortic valve stenosis in the elderly: high prevalence of sleep-related breathing disorders

Emergency Sleep Medicine

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