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Nocturnal Hypoxemia Due to Obstructive Sleep Apnea Is an   Independent Predictor of Poor Prognosis After Myocardial Infarction

View Article: PubMed Central - PubMed

ABSTRACT

Background: Obstructive sleep apnea (OSA) is an important risk factor for the development of cardiovascular diseases including myocardial infarction (MI). The aim of this study was to investigate the effects of OSA on prognosis after MI, and to determine which specific measures of OSA severity best predicted outcomes.

Methods and results: We performed a prospective study, in which 112 patients without a prior diagnosis of sleep apnea underwent comprehensive polysomnography within a median of 7 days after MI. Patients were followed up at 6‐monthly intervals (±2 weeks) for a total of 48 months. Patients classified with central apnea (n=6) or those using continuous positive airway pressure (n=8) after polysomnography were excluded from analyses. The primary end point was major adverse cardiac events, including death from any cause, recurrent MI, unstable angina, heart failure, stroke, and significant arrhythmic events. Forty of 98 patients (41%) had OSA (apnea‐hypopnea index ≥15 events/h). OSA patients had higher major adverse cardiac event rates when compared to those without OSA (47.5% versus 24.1%; χ2=5.41, P=0.020). In a multivariate model that adjusted for clinically relevant variables including age, left ventricular ejection fraction, diabetes mellitus, oxygen desaturation index, and arousal index, significant hypoxemia, as defined by nocturnal nadir oxygen saturation ≤85%, was an independent risk factor for major adverse cardiac events (hazard ratio=6.05, P=0.004) in follow‐up 15 months after baseline.

Conclusions: Nocturnal hypoxemia in OSA is an important predictor of poor prognosis for patients after MI. These findings suggest that routine use of low‐cost nocturnal oximetry may be an economical and practical approach to stratify risk in post‐MI patients.

No MeSH data available.


Related in: MedlinePlus

Flow chart of study progress. CPAP indicates continuous positive airway pressure; MACE, major adverse cardiac events; MI, myocardial infarction; PSG, polysomnography.
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jah31664-fig-0001: Flow chart of study progress. CPAP indicates continuous positive airway pressure; MACE, major adverse cardiac events; MI, myocardial infarction; PSG, polysomnography.

Mentions: We conducted a prospective study of patients admitted for newly diagnosed MI at Mayo Clinic, Rochester, Minnesota. The results of baseline assessments have already been published.7, 20, 21 The diagnosis of MI, made by the attending physician, was defined by the Joint European Society of Cardiology/American College of Cardiology Committee (2000) criteria for “acute, evolving or recent MI.”22 A total of 121 eligible patients were enrolled consecutively (Figure 1). Twenty‐three patients were excluded from the final analysis: 1 due to a prior diagnosis of OSA that was managed with continuous positive airway pressure (CPAP), 1 because of a late final diagnosis of pulmonary embolism and not MI before polysomnography (PSG), 7 patients did not complete PSG testing due to technical, logistical, or clinical reasons, 6 had central sleep apnea, and 8 OSA patients used CPAP after PSG. The final study population consisted of 98 patients who completed overnight PSG within a median of 7 days after MI onset. No patients had acute heart failure at baseline, and only 1 was diagnosed with stable chronic obstructive pulmonary disease. This study was approved by the Mayo Clinic Institutional Review Board, and all patients signed informed consent.


Nocturnal Hypoxemia Due to Obstructive Sleep Apnea Is an   Independent Predictor of Poor Prognosis After Myocardial Infarction
Flow chart of study progress. CPAP indicates continuous positive airway pressure; MACE, major adverse cardiac events; MI, myocardial infarction; PSG, polysomnography.
© Copyright Policy - creativeCommonsBy-nc
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5015271&req=5

jah31664-fig-0001: Flow chart of study progress. CPAP indicates continuous positive airway pressure; MACE, major adverse cardiac events; MI, myocardial infarction; PSG, polysomnography.
Mentions: We conducted a prospective study of patients admitted for newly diagnosed MI at Mayo Clinic, Rochester, Minnesota. The results of baseline assessments have already been published.7, 20, 21 The diagnosis of MI, made by the attending physician, was defined by the Joint European Society of Cardiology/American College of Cardiology Committee (2000) criteria for “acute, evolving or recent MI.”22 A total of 121 eligible patients were enrolled consecutively (Figure 1). Twenty‐three patients were excluded from the final analysis: 1 due to a prior diagnosis of OSA that was managed with continuous positive airway pressure (CPAP), 1 because of a late final diagnosis of pulmonary embolism and not MI before polysomnography (PSG), 7 patients did not complete PSG testing due to technical, logistical, or clinical reasons, 6 had central sleep apnea, and 8 OSA patients used CPAP after PSG. The final study population consisted of 98 patients who completed overnight PSG within a median of 7 days after MI onset. No patients had acute heart failure at baseline, and only 1 was diagnosed with stable chronic obstructive pulmonary disease. This study was approved by the Mayo Clinic Institutional Review Board, and all patients signed informed consent.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Obstructive sleep apnea (OSA) is an important risk factor for the development of cardiovascular diseases including myocardial infarction (MI). The aim of this study was to investigate the effects of OSA on prognosis after MI, and to determine which specific measures of OSA severity best predicted outcomes.

Methods and results: We performed a prospective study, in which 112 patients without a prior diagnosis of sleep apnea underwent comprehensive polysomnography within a median of 7 days after MI. Patients were followed up at 6‐monthly intervals (±2 weeks) for a total of 48 months. Patients classified with central apnea (n=6) or those using continuous positive airway pressure (n=8) after polysomnography were excluded from analyses. The primary end point was major adverse cardiac events, including death from any cause, recurrent MI, unstable angina, heart failure, stroke, and significant arrhythmic events. Forty of 98 patients (41%) had OSA (apnea‐hypopnea index ≥15 events/h). OSA patients had higher major adverse cardiac event rates when compared to those without OSA (47.5% versus 24.1%; χ2=5.41, P=0.020). In a multivariate model that adjusted for clinically relevant variables including age, left ventricular ejection fraction, diabetes mellitus, oxygen desaturation index, and arousal index, significant hypoxemia, as defined by nocturnal nadir oxygen saturation ≤85%, was an independent risk factor for major adverse cardiac events (hazard ratio=6.05, P=0.004) in follow‐up 15 months after baseline.

Conclusions: Nocturnal hypoxemia in OSA is an important predictor of poor prognosis for patients after MI. These findings suggest that routine use of low‐cost nocturnal oximetry may be an economical and practical approach to stratify risk in post‐MI patients.

No MeSH data available.


Related in: MedlinePlus