Central sleep apnea after acute coronary syndrome and association with ticagrelor use
Ph Meurin1, A Ben Driss1, C Defrance1
1Centre de Réadaptation Cardiaque de La Brie, Les Grands Prés, 27 Rue Sainte Christine, 77174, Villeneuve Saint Denis, France.
Insights
Ticagrelor, an antiplatelet medication, may increase the risk of central sleep apnea hypopnea syndrome (CSAHS) in patients recovering from acute coronary syndrome (ACS). Further research is needed to confirm these findings and assess safety.
Area of Science:
- Cardiology
- Sleep Medicine
- Pharmacology
Background:
- Central sleep apnea hypopnea syndrome (CSAHS) is a condition affecting breathing during sleep.
- Ticagrelor is an antiplatelet agent commonly used after acute coronary syndrome (ACS).
- Previous research suggests ticagrelor may influence the apneic threshold, potentially impacting CSAHS development.
Purpose of the Study:
- To investigate the association between ticagrelor administration and the occurrence of CSAHS in patients post-ACS.
- To determine if ticagrelor is a risk factor for developing CSAHS in this population.
Main Methods:
- A prospective study included 121 patients within one year of ACS, excluding those with heart failure or prior sleep apnea.
- Patients underwent overnight sleep studies to diagnose and classify sleep apnea.
- Apnea-hypopnea index (AHI) was used to categorize patients into normal, CSAHS, or obstructive sleep apnea hypopnea syndrome (OSAHS) groups.
Main Results:
- Of 121 patients, 49 (45.3%) had an AHI ≥ 15. 27 patients had CSAHS and 22 had OSAHS.
- Patients taking ticagrelor (n=80) had a significantly higher rate of CSAHS (30%) compared to those not taking ticagrelor (7.3%) (p=0.004).
- Multivariable analysis identified age and ticagrelor administration as independent predictors of CSAHS (p=0.0007 and p=0.0006, respectively).
Conclusions:
- The prevalence of CSAHS after ACS is notable and appears to be associated with ticagrelor use.
- These preliminary findings suggest a potential link between ticagrelor and CSAHS, warranting further investigation.
- The study provides an initial signal regarding the safety profile of ticagrelor in relation to CSAHS.
Study Objectives:
By modifying the apneic threshold, the antiplatelet agent ticagrelor could promote central sleep apnea hypopnea syndrome (CSAHS). We aimed to assess the association between CSAHS and ticagrelor administration.
Methods:
Patients were prospectively included within 1 year after acute coronary syndrome (ACS), if they had no heart failure (and left ventricular ejection fraction ≥ 45%) and no history of sleep apnea. After an overnight sleep study, patients were classified as "normal" with apnea hypopnea index (AHI) < 15, "CSAHS patients" with AHI ≥ 15 mostly with central sleep apneas, and "obstructive sleep apnea hypopnea syndrome (OSAHS) patients" with AHI ≥ 15 mostly with obstructive sleep apneas.
Results:
We included 121 consecutive patients (mean age 56.8 ± 10.8, 88% men, mean body mass index 28.3 ± 4.4 kg/m2, left ventricular ejection fraction 56 ± 5%, at a mean of 67 ± 60 days (median 40 days, interquartile range: 30-80 days) after ACS. In total, 49 (45.3%) patients had AHI ≥ 15 (27 [22.3%] CSAHS %, 22 [18.2%] OSAHS). For 80 patients receiving ticagrelor, 24 (30%) had CSAHS with AHI ≥ 15, and for 41 patients not taking ticagrelor, only 3 (7.3%) had CSAHS with AHI ≥ 15 (chi-square = 8, p = 0.004). On multivariable analysis only age and ticagrelor administration were associated with the occurrence of CSAHS, (p = 0.0007 and p = 0.0006).
Conclusion:
CSA prevalence after ACS is high and seems promoted by ticagrelor administration. Results from monocentric study suggest a preliminary signal of safety. CLINICAL TRIALS.
Gov Id:
NCT03540459.
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