Clinical Implications of Sleep Disordered Breathing in Acute Myocardial Infarction

Abstract

BackgroundSleep 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.MethodsWe 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.ResultsSDB 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.ConclusionThere 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.

Association of inflammation and oxidative stress with obstructive sleep apnea in ischemic stroke patients

“…These adaptive responses to hypoxia contradict previous findings in which TAC was decreased in middle-aged subjects with severe OSA [15], but support the hypothesis of ischemic preconditioning resulting from the nocturnal cycles of hypoxiareoxygenation [28]. Ischemic preconditioning was mostly found in the heart [29,30] but was identified to occur in the brain as well [31,32]. Carotid atherosclerosis has been found to be independently associated with OSA in middle-aged individuals [33].…”

Time Dependence of the Effect of Right Ventricular Dysfunction on Clinical Outcomes After Myocardial Infarction: Role of Pulmonary Hypertension

“…PH has been estimated to be present in >40% of patients following AMI; however, PH could be a result of separate etiologies such as sleep apnea, pulmonary embolism, or chronic lung disease. Chronic lung disease was not associated with higher PASP in a large studies of patients with chronic HF .…”

Sleep-Disordered Breathing and Coronary Artery Disease

“…[74][75][76][77] Moderate and severe SDB is associated with severely impaired endothelial function in patients early after acute MI. 78 After PCI, acute MI patients SDB more often present with systolic retrograde coronary blood flow assessed with Doppler guide wire (31% vs. 6%) and <50% resolution of ST-segment deviation within 30 minutes post PCI (60% vs. 31%).…”

“…Data on long-term outcomes, such as hospital admission for heart failure, recurrent MI or mortality, in cohorts of patients with acute MI and assessment of SDB status are limited to observational studies with less than 200 patients 77,81,82 making it difficult to draw definite conclusions. The first study enrolled 120 patients with an acute MI and had a follow-up period of 18 months.…”