Day–Night Variation of Acute Myocardial Infarction in Obstructive Sleep Apnea

Abstract

OBJECTIVES To evaluate the day-night variation of acute myocardial infarction (MI) in patients with obstructive sleep apnea (OSA). BACKGROUND OSA has a high prevalence and is characterized by acute nocturnal hemodynamic and neurohormonal abnormalities that may increase the risk of MI during the night. METHODS AND RESULTS We prospectively studied 92 patients with MI, for which the time of onset of chest pain was clearly identified. The presence of OSA was determined by overnight polysomnography. For patients with and without OSA we compared the frequency of MI during different intervals of the day based on the onset time of chest pain. The groups had similar prevalence of comorbidities. MI occurred between midnight and 6am in 32% of OSA patients and 7% of non-OSA patients (P=0.01). The odds of having OSA in those patients whose MI occurred between midnight and 6am was six-fold higher than in the remaining 18 hours of the day (95% C.I: 1.3 −27.3, P=0.01). Of all patients having an MI between midnight and 6am, 91% had OSA. CONCLUSIONS The diurnal variation in the onset of MI in OSA patients is strikingly different from the diurnal variation in non-OSA patients. Patients with nocturnal onset of MI have a high likelihood of having OSA. These findings suggest that OSA may be a trigger for MI. Patients having nocturnal onset of MI should be evaluated for OSA, and future research should address the effects of OSA therapy for prevention of nocturnal cardiac events. CONDENSEND ABSTRACT We studied 92 patients with MI, for whom the time of onset of chest pain was clearly identified. MI occurred between midnight and 6am in 32% of OSA patients and 7% of non-OSA patients (P=0.01). The odds of having OSA in those patients whose MI occurred between midnight and 6am was 6 fold higher than in the remaining 18 hours of the day (95% C.I: 1.3 −27.3, P=0.01). The diurnal variation in the onset of MI in patients with OSA is strikingly different; patients with nocturnal onset of MI have a high likelihood of having OSA.

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

“…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).…”

“…Detailed PSG methods have been described previously 7, 20, 21. All patients underwent full‐night PSG between 10:00  pm and 6:00  am .…”

Obstructive sleep apnea syndrome and hypertension: mechanism of the linkage and 24-h blood pressure control

“…Some reports have shown that OSAS is frequently associated with sudden death and acute myocardial infarction during the night. 4,5 Midnight BP surge occurring during apneic episodes may be directly related to the nocturnal occurrence of cardiovascular events.…”

Obstructive sleep apnea, detected by the Berlin Questionnaire: an associated risk factor for coronary artery disease

“…Angiographic analyses have suggested that OSA may contribute to the severity of coronary artery disease 9,10 . OSA may trigger the rupture of vulnerable plaques, leading to acute myocardial infarction 11,12 . OSA has been identified as an independent predictor of angiographic and clinical outcomes in coronary artery disease, such as cardiac death, myocardial infarction and reinfarction or revascularization after percutaneous coronary intervention 13,14 .…”