Coronary revascularization in patients with obstructive sleep apnea syndrome

There is a paucity of clinical information regarding therapy for ischemic heart disease (IHD) in patients with obstructive sleep apnea syndrome (OSAS). We evaluated our experience with surgical revascularization in this subset of patients.

Between January 1998 and April 2001, 20 patients with OSAS underwent isolated coronary artery bypass grafting (CABG). Outcomes were compared to a matched control group consisting of 65 patients.

Patients with OSAS and the controls were similar with regard to age (65.8 years versus 65.2 years), ejection fraction (44.5% versus 46.9%), and systolic blood pressure (141 mmHg versus 142 mmHg). However, they were comparatively heavier (212 lb versus 188 lbs, P < .03), had higher pulmonary artery pressures (42 mmHg versus 34 mmHg, P < .001), higher pulmonary capillary wedge pressures (17 mmHg versus 14 mmHg, P < .01), higher left ventricular end diastolic pressures (20 mmHg versus 18 mmHg, P < .04), and a greater incidence of diabetes (55% versus 30%, P = .049). Patients with OSAS were more likely to require prolonged ventilation (40% versus 0%, P < .001) and tracheostomy (10% versus 0%, P = .01) and have a protracted intensive care unit (ICU) course (9 days versus 3 days, P = .002) and hospitalization (24 versus 13, P = .003). There were no peri-operative deaths, and both groups had significant improvement in angina and functional class. At a mean follow-up of 59 months, angina recurrence was 10% and survival was 95% in patients with OSAS.

Patients with OSAS and IHD requiring coronary revascularization have substantial risk for pulmonary morbidity that impacts the duration of hospitalization but not mortality. Good symptom control and early to mid-term survival may be achieved in this subset of patients with aggressive peri-operative management of their OSAS.