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Obstructive Sleep Apnea and Cardiovascular Events After Percutaneous Coronary Intervention.

Chi-Hang Lee1, Rishi Sethi2, Ruogu Li2

  • 1From Department of Cardiology, National University Heart Centre, Singapore (C-H.L., G.L., C.-Y.K., P.-F.C., M.Y.C., A.M.R., H.-C.T.); Department of Cardiology, King George's Medical University, Lucknow, India (R.S., S.C., A.M., R.B.K.); Department of Cardiology, Shanghai Chest Hospital, China (R.L., X.-X.Y., W.-W.Z.); Department of Cardiology, Tan Tock Seng Hospital, Singapore (H.-H.H.); No (1) 1000-Bed Defence Services General Hospital, Mingaladon, Yangon, Myanmar (T.H.); Cardiac Medical Unit, Grantham Hospital, Hong Kong (M.-H.J.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, China (X.-F.G., Z.G., S.-L.C., J.-J.Z.); Hypertension Unit-Heart Institute (InCor), University of Sao Paulo Medical School, Brazil (S.F.F., C.H.G.U., L.F.D.); Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore (T.-H.O.); Sleep Educators, Antioch, CA (G.R.); and Saw Swee Hock School of Public Health, National University of Singapore, Singapore (B.-C.T.). mdclchr@nus.edu.sg.

Circulation
|May 15, 2016
PubMed
Summary

Obstructive sleep apnea (OSA) is linked to more cardiac events after stenting. This study found OSA independently predicts major adverse cardiac and cerebrovascular events (MACCEs) in patients undergoing percutaneous coronary intervention.

Keywords:
coronary artery diseaseoutcome assessment (health care)percutaneous coronary interventionrisk factorssleep apnea, obstructive

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Area of Science:

  • Cardiology
  • Sleep Medicine
  • Clinical Research

Background:

  • Limited data exists on obstructive sleep apnea (OSA) prognostic significance in coronary artery disease patients.
  • A hypothesis was formed that OSA predicts major adverse cardiac and cerebrovascular events (MACCEs) in patients undergoing percutaneous coronary intervention (PCI).

Purpose of the Study:

  • To investigate the prognostic value of OSA in patients with coronary artery disease undergoing PCI.
  • To determine if OSA is an independent predictor of MACCEs in this patient population.

Main Methods:

  • A prospective, multicenter registry (Sleep and Stent Study) enrolled 1311 patients post-PCI.
  • Patients underwent sleep studies within 7 days of PCI; OSA was defined as an apnea-hypopnea index ≥15 events/hour.
  • MACCEs (composite of cardiovascular mortality, MI, stroke, revascularization) were tracked over a median follow-up of 1.9 years.

Main Results:

  • Obstructive sleep apnea (OSA) was present in 45.3% of the study cohort.
  • The incidence of MACCEs was significantly higher in patients with OSA compared to those without (3-year estimate: 18.9% vs. 14.0%, p=0.001).
  • Multivariate analysis revealed OSA as an independent predictor of MACCEs (adjusted hazard ratio: 1.57; 95% CI: 1.10-2.24; P=0.013).

Conclusions:

  • Obstructive sleep apnea (OSA) is independently associated with an increased risk of subsequent MACCEs in patients following percutaneous coronary intervention.
  • Further research into therapeutic strategies to mitigate OSA-related risks in PCI patients is warranted.