Obstructive Sleep Apnea in Patients Admitted for Acute Myocardial Infarction Prevalence, Predictors, and Effect on Microvascular Perfusion

Departments of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Chest (Impact Factor: 7.48). 07/2009; 135(6):1488-95. DOI: 10.1378/chest.08-2336
Source: PubMed


We investigated the prevalence and predictors of obstructive sleep apnea (OSA) in patients admitted to the hospital for acute myocardial infarction and whether OSA has any association with microvascular perfusion after primary percutaneous coronary intervention (PCI).
Recruited patients were scheduled to undergo an overnight sleep study between 2 and 5 days after primary PCI. An apnea-hypopnea index (AHI) of > or = 15 was considered diagnostic of OSA. Impaired microvascular perfusion after primary PCI was defined as an ST-segment resolution of < or = 70%, myocardial blush grade 0 or 1, or a corrected Thrombolysis in Myocardial Infarction (TIMI) [antegrade flow scale] frame count > 28.
Sleep study was performed in 120 patients and completed in 105 patients (study cohort, mean age 53 +/- 10 years, male 98%) with uncomplicated myocardial infarction. An AHI was > or = 15 in 69 patients (OSA-positive), giving a prevalence of 65.7%. Diabetes mellitus was found to be a significant risk factor for OSA (odds ratio, 2.86; 95% confidence interval, 1.06 to 8.24; p = 0.033). There were no differences between OSA-positive and OSA-negative groups with regard to the percentage of patients with < or = 70% ST-segment resolution (73% vs 64%, respectively; p = 0.411), myocardial blush grade 0 or 1 (39.1% vs 38.9%, respectively; p = 1.000), or corrected TIMI frame count > 28 (21.7% vs 25.0%, respectively; p = 0.807).
We found a high prevalence of previously undiagnosed OSA in patients admitted with acute myocardial infarction. Diabetes mellitus was independently associated with OSA. No evidence indicated that OSA is associated with impaired microvascular perfusion after primary PCI.

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    • "According to a 2012 report by the Organization for Economic Cooperation and Development (OECD), 25.1% of Chilean adults are obese and, among Chilean children aged 5–17 years, 27.1% of girls and 28.6% of boys are overweight or obese [4]. Like excess weight, sleep disorders, particularly sleep apneas, have been associated with hypertension [5] [6], coronary artery disease [7], myocardial infarction [8] [9], heart failure [10], and diabetes [9]. Although reports have been published on the prevalence of obesity and of sleep apnea in Chilean adults and young children [4] [11], few reports have focused attention on the prevalence of obesity and sleep apnea among young adults, particularly college students transitioning from adolescence into adulthood. "
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    ABSTRACT: This cross-sectional study evaluates the prevalence and extent to which high risk for obstructive sleep apnea (OSA) is associated with general obesity and central obesity among college students in Punta Arenas, Chile. Risk for OSA was assessed using the Berlin Questionnaire and trained research nurses measured anthropometric indices. Overweight was defined as body mass index (BMI) of 25-29.9 kg/m(2) and general obesity was defined as BMI ≥ 30 kg/m(2). Central obesity was defined as waist circumference ≥90 centimeters (cm) for males and ≥80 cm for females. Multivariate logistic regression models were fit to obtain adjusted odds ratios (OR) and 95% confidence intervals (CI). Prevalence of high risk for OSA, general obesity, and central obesity were 7.8%, 12.8%, and 42.7%, respectively. Students at high risk for OSA had greater odds of general obesity (OR 9.96; 95% CI: 4.42-22.45) and central obesity (OR 2.78; 95% CI 1.43-5.40). Findings support a strong positive association of high risk for OSA with obesity.
    04/2014; 2014:871681. DOI:10.1155/2014/871681
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    • "Moreover, the decrease in oxygen desaturation in OSA patients was closely related to ST-segment depression, angina and AMI, even if they were not clinically defined as CAD patients [14] [15]. Previously studies have reported that 65.7% of patients presenting with STEMI had undiagnosed OSA and OSA was also an independent risk factor for impaired recovery of left ventricular function after myocardial infarction [16] [17]. However, the effect of OSA on cardiac function and clinical outcomes has not been well studied. "
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    ABSTRACT: Aim . The objective of this study was to investigate the influence of OSA on cardiac function in Chinese patients with ST-elevation myocardial infarction (STEMI) and determine the prognostic impact of OSA among these patients. Methods . In this retrospective study, 198 STEMI patients were enrolled. Doppler echocardiography was performed to detect the effect of OSA on cardiac function. Major adverse cardiac events (MACE) and cardiac mortality were analyzed to determine whether OSA was a clinical prognostic factor; its prognostic impact was then assessed adjusting for other covariates. Results . The echocardiographic results showed that the myocardium of STEMI patients with OSA appeared to be more hypertrophic and with a poorer cardiac function compared with non-OSA STEMI patients. A Kaplan-Meier survival analysis revealed significantly higher cumulative incidence of MACE and cardiac mortality in the OSA group compared with that in the non-OSA group during a mean follow-up of 24 months. Multivariate Cox regression analysis revealed that OSA was an independent risk factor for MACE and cardiac mortality. Conclusion . These results indicate that the OSA is a powerful predictor of decreased survival and exerts negative prognostic impact on cardiac function in STEMI patients.
    The Scientific World Journal 02/2014; 2014(5):908582. DOI:10.1155/2014/908582 · 1.73 Impact Factor
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    • "This disorder, when not correctly treated, has been associated with higher fatal and nonfatal cardiovascular events [2]. Also, OSA has been related to many cardiovascular diseases (CVD) such as heart failure [3], arrhythmias [4], pulmonary hypertension [5], and coronary artery disease (CAD) [6]. Moreover, in recent years OSA has emerged as a major public health problem due to its profound impact on patients' health. "
    Pulmonary Medicine 02/2014; 2014:690273. DOI:10.1155/2014/690273
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