scholarly journals Clinical significance of obstructive sleep apnea in patients with acute coronary syndrome in relation to diabetes status

2019 ◽  
Vol 7 (1) ◽  
pp. e000737 ◽  
Author(s):  
Xiao Wang ◽  
Jingyao Fan ◽  
Yunhui Du ◽  
Changsheng Ma ◽  
Xinliang Ma ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Acute Coronary Syndrome ◽  
Sleep Apnea ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Apnea Hypopnea Index ◽  
Coronary Syndrome ◽  
Diabetes Status ◽  
Obstructive Sleep ◽  
Increased Risk

ObjectiveThe prognostic significance of obstructive sleep apnea (OSA) in patients with acute coronary syndrome (ACS) according to diabetes mellitus (DM) status remains unclear. We aimed to elucidate the association of OSA with subsequent cardiovascular events in patients with ACS with or without DM.Research design and methodsIn this prospective cohort study, consecutive eligible patients with ACS underwent cardiorespiratory polygraphy between June 2015 and May 2017. OSA was defined as an Apnea Hypopnea Index ≥15 events/hour. The primary end point was major adverse cardiovascular and cerebrovascular events (MACCEs), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure.ResultsAmong 804 patients, 248 (30.8%) had DM and 403 (50.1%) had OSA. OSA was associated with 2.5 times the risk of 1 year MACCE in patients with DM (22.3% vs 7.1% in the non-OSA group; adjusted HR (HR)=2.49, 95% CI 1.16 to 5.35, p=0.019), but not in patients without DM (8.5% vs 7.7% in the non-OSA group, adjusted HR=0.94, 95% CI 0.51 to 1.75, p=0.85). Patients with DM without OSA had a similar 1 year MACCE rate as patients without DM. The increased risk of events was predominately isolated to patients with OSA with baseline glucose or hemoglobin A1c levels above the median. Combined OSA and longer hypoxia duration (time with arterial oxygen saturation <90%>22 min) further increased the MACCE rate to 31.0% in patients with DM.ConclusionsOSA was associated with increased risk of 1 year MACCE following ACS in patients with DM, but not in non-DM patients. Further trials exploring the efficacy of OSA treatment in high-risk patients with ACS and DM are warranted.

Abstract 16780: Effects of Ethnicity on the Prevalence of Obstructive Sleep Apnea in Patients With Acute Coronary Syndrome: A Pooled Analysis of the ISAACC Trial and Sleep and Stent Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Chieh Yang Koo ◽  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Acute Coronary Syndrome ◽  
Sleep Apnea ◽  
Chinese Population ◽  
Pooled Analysis ◽  
Forest Plot ◽  
Apnea Hypopnea Index ◽  
Sleep Study ◽  
Coronary Syndrome ◽  
Obstructive Sleep

Objective: Obstructive sleep apnea (OSA) is an increasing yet under-recognized risk factor for acute coronary syndrome (ACS). We sought to determine the effects of ethnicity on the prevalence of OSA in patients presenting with ACS who participated in an overnight sleep study. Methods: A pooled analysis using patient-level data from the ISAACC Trial and Sleep and Stent Study was performed. In both of these studies, patients presenting with ACS were recruited to undergo an overnight sleep study. OSA was defined as an apnea-hypopnea index (AHI) of ≥15. A bivariate analysis of the factors affecting AHI and an age-adjusted analysis of the effect of BMI on sleep apnea according to ethnicity were conducted. Results: A total of 1961 patients were analyzed, including Spanish (53.6%, n=1050), Chinese (25.5%, n=500), Indian (12.0%, n=235), Malay (6.1%, n=119), Brazilian (1.7%, n=34) and Burmese (1.2%, n=23) populations. Significant differences in body mass index (BMI) were found among the various ethnic groups, averaging from 25.3 kg/m2 for Indians and 25.4 kg/m2 for Chinese to 28.6 kg/m2 for Spaniards. The prevalence of OSA was highest in the Spanish (63.1%), followed by the Chinese (50.2%), Malay (47.9%), Burmese (43.5%), Brazilian (41.2%), and Indian patients. Figure 1 shows the forest plot of the prevalence of OSA among the various ethnicities. A significant interaction between BMI and ethnicity to predict OSA was observed. The estimated odds ratio of BMI on OSA was highest in the Chinese population (1.17; 95% confidence interval: 1.10-1.24), but was not significant in the Spanish, Burmese or Brazilian populations. The area under the curve for the Asian patients (ranging from 0.6365 to 0.6692) was higher than that for the Spanish patients (0.5161). Conclusion: There was significant ethnic variation in the prevalence of OSA in patients with ACS, and the magnitude of the effect of BMI on OSA was greater in the Chinese population than in the Spanish patients.

scholarly journals Effect of Obstructive Sleep Apnea and CPAP Treatment on Cardiovascular Outcomes in Acute Coronary Syndrome in the RICCADSA Trial

2020 ◽  
Vol 9 (12) ◽  
pp. 4051
Author(s):  
Yüksel Peker ◽  
Erik Thunström ◽  
Helena Glantz ◽  
Christine Eulenburg
Keyword(s):  
Obstructive Sleep Apnea ◽  
Acute Coronary Syndrome ◽  
Sleep Apnea ◽  
Reference Group ◽  
Cardiovascular Outcomes ◽  
Apnea Hypopnea Index ◽  
Coronary Syndrome ◽  
Cpap Treatment ◽  
Obstructive Sleep ◽  
The Impact

We aimed to address the impact of OSA and its treatment with continuous positive airway pressure (CPAP) on major adverse cardiovascular and cerebrovascular events (MACCE) in patients with acute coronary syndrome (ACS). In this current analysis of the revascularized ACS subgroup (n = 353) of the Randomized Intervention with CPAP in Coronary Artery Disease and Obstructive Sleep Apnea (RICCADSA) trial (Trial Registry: ClinicalTrials.gov; No: NCT 00519597), participants with non-sleepy OSA (apnea-hypopnea-index [AHI] ≥ 15 events/h on a home sleep apnea testing, and Epworth Sleepiness Scale [ESS] score < 10; n = 171) were randomized to CPAP (n = 86) or no-CPAP (n = 85). The sleepy OSA patients (AHI ≥ 15 events/h and ESS ≥ 10) who were offered CPAP, and the ones with no-OSA (AHI < 5 events/h) were included in the observational arm. A post-hoc analysis was done to compare untreated OSA (no-CPAP; n = 78) and nonadherent sleepy/non-sleepy OSA (n = 96) with the reference group without OSA (n = 81). The primary endpoint (the first event of repeat revascularization, myocardial infarction, stroke or cardiovascular mortality) during a median 4.7-year follow-up was evaluated in time-dependent Cox proportional hazards models adjusted for confounding factors. The incidence of MACCE did not differ significantly in intention-to-treat population. On-treatment analysis showed a significant risk reduction in those who used CPAP for ≥4 vs. <4 h/day or did not receive treatment (adjusted hazard ratio [HR] 0.17; 95% confidence interval [CI] 0.03–0.81; p = 0.03). Compared with the reference group, nonadherent/untreated OSA was associated with an increased cardiovascular risk (adjusted HR 1.97, 95% CI 1.03–3.77; p = 0.04). We conclude that OSA is an independent risk factor for adverse cardiovascular outcomes in patients with ACS. CPAP treatment may reduce this risk, if the device is used at least 4 h/day.

scholarly journals The Importance of Apneic Events in Obstructive Sleep Apnea Associated with Acute Coronary Syndrome

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
George Calcaianu ◽  
Didier Bresson ◽  
Mihaela Calcaianu ◽  
Beatrice Morisset ◽  
Tarek El-Nazer ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Acute Coronary Syndrome ◽  
Sleep Apnea ◽  
Troponin I ◽  
Apnea Hypopnea Index ◽  
Syntax Score ◽  
Arousal Index ◽  
Coronary Syndrome ◽  
Obstructive Sleep ◽  
The Impact

Background. Obstructive sleep apnea (OSA) is a potential cardiovascular risk factor. However, there is currently no prominent screening strategy for its diagnosis in patients with acute coronary syndrome (ACS). The aim of this study was to establish the impact of apneic events in case of OSA associated with ACS. Methods. Between January 1st and June 30th, fifty-three subjects with ACS (first acute myocardial infarction) were prospectively evaluated for OSA. Each patient was evaluated by polysomnography (PSG) two months after the ACS. Results. Mean age of 59±9,6 years, 81,1% males, BMI at 28,5±4,2 kg/m2, neck circumference of 42,5±12,6 cm, and waist circumference os 102,5±16,5 cm. The majority of patients (73,6%) had moderate to severe OSA (apnea-hypopnea index (AHI) ≥ 15/h and arousal index ≥ 10/h). We defined the apneic coefficient (AC) as the ratio between apnea index (AI) and AHI. We chose as cut-off the median value of apnea coefficient in our population which was at 37%. The patients with a higher AC (AC ≥ 37% versus AC < 37%) had higher levels of Troponin-I (63,4±63,2 versus 29,7±36,1 ng/mL, p=0,016), higher levels of NT-proBNP (1879,8±2141,8 versus 480±621,3 pg/mL, p=0,001), higher SYNTAX score (15,8±11,5 versus 10,2±5,9, p=0,049), and lower left ventricle ejection fraction (LVEF 53,3±11,4 versus 59,4±6,4%, p=0,023) and were more likely to have a STEMI (21 patients (77,7%) vesus 14 patients (53,8%), p=0,031). Conclusion. An apneic coefficient (AI/AHI) ≥ 37% is correlated with more severe cardiac impairment, as well as higher hypoxemia and arousal index.

S248 – Supraglottoplasty for Laryngomalacia with Sleep Apnea

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P158-P158
Author(s):  
Mark E Zafereo ◽  
Rodney J Taylor ◽  
Kevin D Pereira
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Apnea Hypopnea Index ◽  
Obstructive Apnea ◽  
Respiratory Parameters ◽  
Obstructive Sleep ◽  
Respiratory Disturbance ◽  
Student’S T

Objectives To determine if supraglottoplasty is effective in reversing abnormal respiratory parameters in children with laryngomalacia and obstructive sleep apnea. Methods 10 patients with laryngomalacia and obstructive sleep apnea as documented by polysomnography underwent supraglottoplasty at a tertiary referral children's hospital between 2005 and 2007. Retrospective data collection included age, findings on flexible and rigid endoscopy, type of procedure performed, and postoperative course. The postoperative polysomnographies were reviewed to identify changes in obstructive apnea index (OAI), obstructive apnea/hypopnea index (OAHI), respiratory disturbance index (RDI), and low arterial oxygen saturation (O2 nadir) after supraglottoplasty. Pre- and postoperative mean data were calculated, and comparisons were made with a Student's T-test. Results All 10 patients were successfully extubated following supraglottoplasty. There were no perioperative or postoperative complications, and no patient required a subsequent airway procedure. Each patient had a postoperative nocturnal polysomnography performed following supraglottoplasty at 11 weeks (range 2–29 weeks). Caregivers reported mild improvement (10%), significant improvement (70%), and complete resolution (20%) of stridor and nocturnal snoring at a follow-up visit 4 weeks after hospital discharge. Marked improvements were observed in OAI, OAHI, RDI and O2 nadir, all of which were statistically significant (p<0.05). Conclusions Polysomnography should be included in the initial evaluation of infants with laryngomalacia to rule out obstructive sleep apnea. Supraglottoplasty is an effective treatment for infants with laryngomalacia and obstructive sleep apnea. The significant benefits of the procedure outweigh the low morbidity. Improvement after surgery can be reliably confirmed by polysomnography.

Obstructive Sleep Apnea in Children With Down Syndrome

PEDIATRICS ◽  
1991 ◽  
Vol 88 (1) ◽  
pp. 132-139
Author(s):  
Carole L. Marcus ◽  
Thomas G. Keens ◽  
Daisy B. Bautista ◽  
Walter S. von Pechmann ◽  
Sally L. Davidson Ward
Keyword(s):  
Obstructive Sleep Apnea ◽  
Down Syndrome ◽  
Sleep Apnea ◽  
Arterial Oxygen Saturation ◽  
Sleep Apnea Syndrome ◽  
Arterial Oxygen ◽  
Children With Down Syndrome ◽  
Obstructive Sleep ◽  
Apnea Syndrome ◽  
End Tidal

Children with Down syndrome have many predisposing factors for the obstructive sleep apnea syndrome (OSAS), yet the type and severity of OSAS in this population has not been characterized. Fifty-three subjects with Down syndrome (mean age 7.4 ± 1.2 [SE] years; range 2 weeks to 51 years) were studied. Chest wall movement, heart rate, electrooculogram, end-tidal Po2 and Pco2, transcutaneous Po2 and Pco2, and arterial oxygen saturation were measured during a daytime nap polysomnogram. Sixteen of these children also underwent overnight polysomnography. Nap polysomnograms were abnormal in 77% of children; 45% had obstructive sleep apnea (OSA), 4% had central apnea, and 6% had mixed apneas; 66% had hypoventilation (end-tidal Pco2, &gt;45 mm Hg) and 32% desaturation (arterial oxygen saturation &lt;90%). Overnight studies were abnormal in 100% of children, with OSA in 63%, hypoventilation in 81%, and desaturation in 56%. Nap studies significantly underestimated the presence of abnormalities when compared to overnight polysomnograms. Seventeen (32%) of the children were referred for testing because OSAS was clinically suspected, but there was no clinical suspicion of OSAS in 36 (68%) children. Neither age, obesity, nor the presence of congenital heart disease affected the incidence of OSA, desaturation, or hypoventilation. Polysomnograms improved in all 8 children who underwent tonsilletomy and adenoidectomy, but they normalized in only 3. It is concluded that children with Down syndrome frequently have OSAS, with OSA, hypoxemia, and hypoventilation. Obstructive sleep apnea syndrome is seen frequently in those children in whom it is not clinically suspected. It is speculated that OSAS may contribute to the unexplained pulmonary hypertension seen in children with Down syndrome.

Defining Risk of Postoperative Obstructive Sleep Apnea in Patients With 22q11.2DS Undergoing Pharyngeal Flap Surgery for Velopharyngeal Dysfunction Using Polysomnographic Evaluation

2020 ◽  
Vol 57 (7) ◽  
pp. 808-818
Author(s):  
Alfred Lee ◽  
Brian L. Chang ◽  
Cynthia Solot ◽  
Terrence B. Crowley ◽  
Vamsee Vemulapalli ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Tertiary Care ◽  
22Q11.2 Deletion Syndrome ◽  
Deletion Syndrome ◽  
Apnea Hypopnea Index ◽  
Pressure Therapy ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Pharyngeal Flap

Objective: To determine pre- and postoperative prevalence of obstructive sleep apnea (OSA) in patients with 22q11.2 deletion syndrome (DS) undergoing wide posterior pharyngeal flap (PPF) surgery for velopharyngeal dysfunction (VPD). Design: Retrospective study using pre- and postoperative polysomnography (PSG) to determine prevalence of OSA. Medical records were reviewed for patients’ medical comorbidities. Parents were surveyed about snoring. Setting: Academic tertiary care pediatric hospital. Patients: Forty patients with laboratory confirmed 22q11.2DS followed over a 6-year period. Interventions: Pre- and postoperative PSG, speech evaluation, and parent surveys. Main Outcome Measure: Severity and prevalence of OSA, defined by obstructive apnea hypopnea index (OAHI), before and after PPF surgery to determine whether PPF is associated with increased risk of OSA. Results: Mean OAHI did not change significantly after PPF surgery (1.1/h vs 2.1/h, P = .330). Prevalence of clinically significant OSA (OAHI ≥ 5) was identical pre- and postoperatively (2 of 40), with both cases having severe-range OSA requiring positive airway pressure therapy. All other patients had mild-range OSA. Nasal resonance was graded as severe preoperatively in 85% of patients. None were graded as severe postoperatively. No single patient factor or parent-reported concern predicted risk of OSA (OAHI ≥ 1.5). Conclusions: Patients with 22q11.2DS are medically complex and are at increased risk of OSA at baseline. Wide PPF surgery for severe VPD does not significantly increase risk of OSA. Careful perioperative planning is essential to optimize both speech and sleep outcomes.

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