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Sleep-disordered breathing and myocardial ischemia in patients with coronary artery disease
T Mooe1, K A Franklin, U Wiklund
1Department of Cardiology, University Hospital, Umeå, Sweden. thomas.mooe@medicin.umu.se
Insights
Nocturnal myocardial ischemia is common in angina patients. A link to sleep-disordered breathing occurs in a minority, particularly men with severe breathing issues.
Area of Science:
- Cardiology
- Sleep Medicine
- Respiratory Medicine
Background:
- Nocturnal myocardial ischemia is a concern in patients with angina pectoris.
- Sleep-disordered breathing, including apneas and oxygen desaturations, may influence cardiac events.
- Understanding this relationship is crucial for patient management.
Purpose of the Study:
- To investigate the occurrence of nocturnal myocardial ischemia.
- To determine the association between sleep-disordered breathing (apneas and oxygen desaturations) and myocardial ischemia in patients with angina pectoris.
Main Methods:
- An observational study was conducted.
- Overnight sleep studies and Holter recordings were used to assess disordered breathing, heart rates, and ST-segment depressions.
- 132 men and 94 women referred for coronary angiography were included.
Main Results:
- ST-segment depressions occurred in 59% of patients, with 31% experiencing them nocturnally.
- A temporal association between ST-segment depression and breathing events was observed in 19% of nocturnal events.
- This association was more frequent in men and those with more severe sleep-disordered breathing.
Conclusions:
- Nocturnal myocardial ischemia is prevalent in patients with angina.
- A direct temporal link between sleep-disordered breathing and myocardial ischemia is found in a subset of patients.
- The relationship is more pronounced in men and individuals with severe sleep-disordered breathing.
Study Objectives:
To examine the occurrence of nocturnal myocardial ischemia and its relationship to sleep-disordered breathing (apneas and oxygen desaturations) in randomly selected men and women undergoing coronary angiography because of angina pectoris.
Design:
An observational study using an overnight sleep study and Holter recording to examine disordered breathing (oxyhemoglobin desaturations > or = 4% and apnea-hypopneas), heart rates, and ST-segment depressions (> or = 1 mm, > or = 1 min).
Setting:
University Hospital, Umeå, a teaching hospital in northern Sweden.
Patients:
One hundred thirty-two men and 94 women referred for consideration of coronary intervention were randomly included, by lot.
Results:
ST-segment depressions occurred in 59% (134 of 226) of the patients, and nocturnal ST-segment depressions occurred in 31% (69 of 226). A ST-segment depression occurred within 2 min after an apnea-hypopnea or desaturation in 12% (27 of 226) of patients. This temporal association was seen in 19% of nocturnal ST-segment depressions (71 of 366), more frequently in men (p < 0.01) and in more severely disordered breathing (p < 0.001). Most of these ST-segment depressions were preceded by a series of breathing events: three or more apnea-hypopneas or desaturations or both in 70% (50 of 71).
Conclusion:
Episodes of nocturnal myocardial ischemia are common in patients with angina pectoris. However, a temporal relationship between sleep-disordered breathing and myocardial ischemia is present only in a minority of the patients, but occurs more frequently in men and in more severely disordered breathing.