Scientific Investigations
Severe Obstructive Sleep Apnea and Outcomes Following Myocardial Infarction
http://dx.doi.org/10.5664/jcsm.1464
Chi-Hang Lee, M.D.1,2; See-Meng Khoo, MB.BS.1; Mark Y. Chan, MB.BS.1,2; Hwee-Bee Wong, Ph.D.3; Adrian F. Low, MB.BS.1,2; Qian-Hui Phua, B.Sc.1; A. Mark Richards, M.D.1,4; Huay-Cheem Tan, MB.BS.2; Tiong-Cheng Yeo, MB.BS.2
1Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore; 2National University Heart Centre Singapore, National University Health System; 3Health Services Research and Evaluation Division, Ministry of Health, Singapore; 4Cardiovascular Research Institute, National University of Singapore
Study Objective:
We sought to determine the effect of severe obstructive sleep apnea (OSA) on long-term outcomes after myocardial infarction. We hypothesized that severe OSA was associated with lower event-free survival rate after ST-segment elevation myocardial infarction (STEMI).
Methods:
A total of 120 patients underwent an overnight sleep study during index admission for STEMI. Severe OSA was defined as apnea hypopnea index (AHI) ≥ 30, and non-severe OSA defined as AHI < 30.
Results:
Among the 105 patients who completed the study, 44 (42%) had severe OSA and 61 (58%) non-severe OSA. The median creatine kinase level and mean left ventricular systolic function were similar between the 2 groups. None of the 105 study patients had received treatments for OSA. Between 1- and 18-month follow-up, the severe OSA group incurred 1 death, 2 reinfarctions, 1 stroke, 6 unplanned target vessel revascularizations, and 1 heart failure hospitalization. In contrast, there were only 2 unplanned target vessel revascularizations in the non-severe OSA group. The incidence of major adverse events was significantly higher in the severe OSA group (15.9% versus 3.3%, adjusted hazard ratios: 5.36, 95% CI: 1.01 to 28.53, p = 0.049). Kaplan-Meier event-free survival curves showed the event-free survival rates in the severe OSA group was significantly worse than that in the non-severe OSA group (p = 0.021, log-rank test).
Conclusion:
42% of the patients admitted with STEMI have undiagnosed severe OSA. Severe OSA carries a negative prognostic impact for this group of patients. It is associated with a lower event-free survival rate at 18-month follow-up.
Citation:
Lee CH; Khoo SM; Chan MY; Wong HB; Low AF; Phua QH; Richards AM; Tan HC; Yeo TC. Severe obstructive sleep apnea and outcomes following myocardial infarction. J Clin Sleep Med 2011;7(6):616–621.
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