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Clinical implications of sleep disordered breathing in acute myocardial infarction.

Aronson D, Nakhleh M, Zeidan-Shwiri T, Mutlak M, Lavie P, Lavie L - PLoS ONE (2014)

Bottom Line: This prospective study investigated whether the metabolic perturbations associated with SDB are present when these patients develop AMI and if they affect clinical outcomes.SDB in the setting of AMI is associated with higher pulmonary artery systolic pressure.SDB was not associated with adverse clinical outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Rambam Medical Center, Haifa, Israel.

ABSTRACT

Background: Sleep disordered breathing (SDB), characterized by nightly intermittent hypoxia, is associated with multiple pathophysiologic alterations that may adversely affect patients with acute myocardial infarction (AMI). This prospective study investigated whether the metabolic perturbations associated with SDB are present when these patients develop AMI and if they affect clinical outcomes.

Methods: We prospectively enrolled 180 AMI patients. SDB was defined as oxygen desaturation index (ODI) >5 events/hour based on a Watch Pat-100 sleep study. Blood samples were obtained for high-sensitivity C-reactive protein (hs-CRP) and markers of oxidative stress (lipid peroxides [PD] and serum paraoxonase-1 [PON-1] (arylesterase activity). Echocardiography was performed to evaluate cardiac dimensions and pulmonary artery systolic pressure.

Results: SDB was present in 116 (64%) patients. Hs-CRP levels, PD and PON-1 were similar in patients with and without SDB. Echocardiography revealed higher left atrial dimension (4.1 ± 0.5 vs 3.8 ± 0.5 cm; P = 0.003) and a significant positive correlation between ODI and pulmonary artery systolic pressure (r = 0.41, P<0.0001). After a median follow up of 68 months, no significant differences were observed between the study groups with regard to clinical outcomes, including death, heart failure, myocardial infarction and unstable angina.

Conclusion: There is a high prevalence of previously undiagnosed SDB among patients with AMI. SDB in the setting of AMI is associated with higher pulmonary artery systolic pressure. SDB was not associated with adverse clinical outcomes.

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Related in: MedlinePlus

Receiver-operating characteristic curves for the performance of ODI in the prediction of mortality (A), congestive heart failure (B), recurrent infarction (C) and the combined endpoint of mortality, readmission for heart failure and recurrent infarctions (D).
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pone-0088878-g003: Receiver-operating characteristic curves for the performance of ODI in the prediction of mortality (A), congestive heart failure (B), recurrent infarction (C) and the combined endpoint of mortality, readmission for heart failure and recurrent infarctions (D).

Mentions: The median follow-up after hospital discharge was 68 months. The rates of hard cardiovascular endpoints including death, readmission for CHF and recurrent infarctions were generally low. For the clinical outcomes analysis, 4 patients were censored at the time of CPAP therapy initiation. Figure 2 displays the Kaplan-Meier curves for the endpoint of mortality, readmission for heart failure, recurrent infarction and the combined endpoint of mortality heart failure and recurrent infarctions. Figure 3 shows the area under the ROC curves for the respective endpoints.


Clinical implications of sleep disordered breathing in acute myocardial infarction.

Aronson D, Nakhleh M, Zeidan-Shwiri T, Mutlak M, Lavie P, Lavie L - PLoS ONE (2014)

Receiver-operating characteristic curves for the performance of ODI in the prediction of mortality (A), congestive heart failure (B), recurrent infarction (C) and the combined endpoint of mortality, readmission for heart failure and recurrent infarctions (D).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921254&req=5

pone-0088878-g003: Receiver-operating characteristic curves for the performance of ODI in the prediction of mortality (A), congestive heart failure (B), recurrent infarction (C) and the combined endpoint of mortality, readmission for heart failure and recurrent infarctions (D).
Mentions: The median follow-up after hospital discharge was 68 months. The rates of hard cardiovascular endpoints including death, readmission for CHF and recurrent infarctions were generally low. For the clinical outcomes analysis, 4 patients were censored at the time of CPAP therapy initiation. Figure 2 displays the Kaplan-Meier curves for the endpoint of mortality, readmission for heart failure, recurrent infarction and the combined endpoint of mortality heart failure and recurrent infarctions. Figure 3 shows the area under the ROC curves for the respective endpoints.

Bottom Line: This prospective study investigated whether the metabolic perturbations associated with SDB are present when these patients develop AMI and if they affect clinical outcomes.SDB in the setting of AMI is associated with higher pulmonary artery systolic pressure.SDB was not associated with adverse clinical outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Rambam Medical Center, Haifa, Israel.

ABSTRACT

Background: Sleep disordered breathing (SDB), characterized by nightly intermittent hypoxia, is associated with multiple pathophysiologic alterations that may adversely affect patients with acute myocardial infarction (AMI). This prospective study investigated whether the metabolic perturbations associated with SDB are present when these patients develop AMI and if they affect clinical outcomes.

Methods: We prospectively enrolled 180 AMI patients. SDB was defined as oxygen desaturation index (ODI) >5 events/hour based on a Watch Pat-100 sleep study. Blood samples were obtained for high-sensitivity C-reactive protein (hs-CRP) and markers of oxidative stress (lipid peroxides [PD] and serum paraoxonase-1 [PON-1] (arylesterase activity). Echocardiography was performed to evaluate cardiac dimensions and pulmonary artery systolic pressure.

Results: SDB was present in 116 (64%) patients. Hs-CRP levels, PD and PON-1 were similar in patients with and without SDB. Echocardiography revealed higher left atrial dimension (4.1 ± 0.5 vs 3.8 ± 0.5 cm; P = 0.003) and a significant positive correlation between ODI and pulmonary artery systolic pressure (r = 0.41, P<0.0001). After a median follow up of 68 months, no significant differences were observed between the study groups with regard to clinical outcomes, including death, heart failure, myocardial infarction and unstable angina.

Conclusion: There is a high prevalence of previously undiagnosed SDB among patients with AMI. SDB in the setting of AMI is associated with higher pulmonary artery systolic pressure. SDB was not associated with adverse clinical outcomes.

Show MeSH
Related in: MedlinePlus