Excessive Daytime Sleepiness is Associated with Longer Culprit Lesion and Adverse Outcomes in Patients with Coronary Artery Disease

Lee, Chi‐Hang; Ng, Wan Sing; Hau, William; Ho, Hee‐Hwa; Tai, Bee–Choo; Chan, Mark Y.; Richards, A. Mark; Tan, Huay‐Cheem

doi:10.5664/jcsm.3266

Cited by 23 publications

(15 citation statements)

References 26 publications

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“…As an easily recognized complaint, EDS can be readily incorporated into routine evaluations for patients receiving secondary prevention therapy after MI. The prognostic value of EDS in post-MI patients is a novel finding and is consistent with previous studies in non-MI patients, [5][6][7] although other investigations did not report significant correlation of EDS with CVD prevalence in a cross-sectional study 20 or incidence of new-onset CVD in longitudinal observation. 21 A number of factors have been hypothesized as accounting for the unfavorable cardiovascular profile in sleepy individuals.…”

Section: Discussionsupporting

confidence: 90%

“…Excessive daytime sleepiness (EDS) is a common symptom in patients with SDB and has been associated with an increased risk of motor vehicle accidents, occupational injuries, and the development of cerebrovascular diseases and CVD 3, 4. Moreover, longitudinal studies have shown that EDS is an independent risk factor for adverse outcomes in patients with coronary artery disease5 and predicts cardiovascular mortality 6, 7. Although continuous positive airway pressure (CPAP) is recommended for patients with moderate to severe SDB,8 evidence for its use in SDB patients with CVD but without EDS is questionable 9, 10.…”

Section: Introductionmentioning

confidence: 99%

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Excessive Daytime Sleepiness Independently Predicts Increased Cardiovascular Risk After Myocardial Infarction

Xie

Kuniyoshi

Covassin

et al. 2018

JAHA

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BackgroundExcessive daytime sleepiness (EDS), a common symptom among patients with sleep‐disordered breathing, is closely associated with the development of cardiovascular diseases, but its long‐term prognostic value is not completely understood. The aim of this study was to investigate whether EDS would be an independent prognostic factor after myocardial infarction.Methods and ResultsWe prospectively recruited 112 post–myocardial infarction patients. The Epworth Sleepiness Scale was completed before polysomnography, and EDS was defined as a score ≥11. After exclusion of 8 patients who accepted treatment with continuous positive airway pressure, 104 patients were followed up for 48 months. The primary composite end point was major adverse cardiac events. Patients with EDS had higher rates of major adverse cardiac events (48.4% versus 27.4%, χ2=5.27, P=0.022) and reinfarction (29.0% versus 5.5%, χ2=13.51, P=0.0002) compared with those without EDS. In the Cox proportional hazards model, patients with EDS had 2.15 times (95% confidence interval, 1.08–4.18; P=0.030) higher crude risk of major adverse cardiac events, with prognostic significance persisting after adjusting for age, diabetes mellitus, depression, left ventricular ejection fraction, apnea–hypopnea index, and nocturnal nadir oxygen saturation (hazard ratio: 2.13, 95% confidence interval, 1.04–4.26, P=0.039). Furthermore, among participants with moderate to severe sleep‐disordered breathing, the presence of EDS was associated with higher risk of major adverse cardiac events than those without EDS, after adjusting for age and nadir oxygen saturation (hazard ratio: 3.17, 95% confidence interval, 1.22–7.76, P=0.019).Conclusions EDS may be an independent prognostic factor of adverse outcome in post–myocardial infarction patients with moderate to severe sleep‐disordered breathing. Evaluation of EDS may shed new light on risk stratification and identify treatment responders for this patient population.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Excessive Daytime Sleepiness Independently Predicts Increased Cardiovascular Risk After Myocardial Infarction

Xie

Kuniyoshi

Covassin

et al. 2018

JAHA

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“…The association with the SAOS was clearly demonstrated; however, in patients with cardiovascular disorders this association proved to be limited. Furthermore, myocardial ischemia or heart failure alone can lead to fatigue and excessive daytime sleepiness, even in the absence of SAOS, and medications for cardiac problems, such as β-blockers, can also lead to excessive daytime sleepiness [29][30][31] . Use of nasoenteric probe in adult emergency service There was a statistically significant association between pulmonary diseases and orotracheal intubation (OTI).…”

Section: Discussionmentioning

confidence: 99%

Profile of patients using nasoenteric probe at the adult emergency service in a public hospital

2018

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Introduction: Part of the prognosis of hospitalized patient depends on nutritional status and the safety and efficacy of the feeding administration route. Therefore, the aim of this study was to identify data on the indication of nasoenteric tube (NET) prescription to analyze the profile of these patients. Methods: A retrospective cross-sectional study was carried out with data collection in medical records of patients over 18 years of age, of both sexes, treated at the Emergency Adult Service (EAS), using NET. Results: there was a predominance of females (51.9%); neurological disease was the most prevalent underlying disease, and 57.8% had more than one diagnosed disease. Malnutrition, bronchopneumonia, and dysphagia were present in 23.6%, 27% and 40% of the cases, respectively. There was a request for speech-language evaluation in only 8.7% of the patients. And 80.7% did not use NET prior to emergency care. Regarding the indications for the use of NET by group of underlying disease, low food intake was the most prevalent clinical reason described in the medical records, followed by dysphagia, with a higher prevalence of patients taking NET for nutritional reasons. There was no justification for prescription in 15.2% of the sample. There was an association between the variables bronchopneumonia and dysphagia (p = 0.01). Conclusion: It was verified that in the studied population there are risk factors for dysphagia. The analysis of the population profile in the present study contributed to increased knowledge and information about this population regarding the criteria for indication of the use of the alternative route.

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“…This symptom has been suggested as a risk factor for the aggravation of cardiovascular diseases, still poorly investigated in clinical evaluations in conjunction with other factors, (6,13) and the results of this study corroborate these findings. It is noteworthy that in longitudinal studies, the authors showed that subjects with excessive daytime sleepiness were at increased risk for cardiovascular diseases (14,20) and AMI. (6) The scores obtained in the Epworth Sleepiness Scale were higher for males and the age group of 60 years or older, which is similar to the results found in other studies, (6,(21)(22)(23) though not reaching statistical significance.…”

Section: Discussionmentioning

confidence: 99%

“…(3) It is defined as the increased propensity to sleep in circumstances deemed inappropriate, (9) needing naps during the day. (10) Studies show the association of excessive daytime sleepiness with cardiovascular events, (3,(10)(11)(12)(13)(14) resulting in an increase of 33% for the risk of mortality. (6) A screening for the presence of excessive daytime sleepiness can contribute to detect individuals at high risk for these diseases.…”

Section: Introductionmentioning

confidence: 99%

Sonolência diurna excessiva nos pacientes com infarto agudo do miocárdio

Andrechuk

Ceolim

2015

Acta paul. enferm.

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Objective: To characterize daytime sleepiness in patients with acute myocardial infarction and identify the sociodemographic and clinical characteristics associated with excessive daytime sleepiness in these patients. Methods: A cross-sectional study with 113 patients (mean age of 59.7 years; 70.8% male), in which were used an instrument for the sociodemographic and clinical characterization, and the Epworth Sleepiness Scale. Results: Excessive daytime sleepiness was identified in 33 patients (29.2%). Those with a body mass index above 30 kg/m 2 and those who progressed to clinical worsening obtained a higher score in the Epworth Sleepiness Scale, compared to those with a body mass index less than 30 kg/m 2 and clinical improvement. The patients aged 60 years or more, those separated, and with body mass index greater than 30 kg/m 2 were more likely to mention excessive daytime sleepiness. Conclusion: Identifying individuals with excessive daytime sleepiness should be part of the routine work of nurses for the prevention of cardiovascular diseases. ResumoObjetivos: Caracterizar a sonolência diurna em pacientes com infarto agudo do miocárdio e identificar as características sociodemográficas e clínicas associadas à sonolência diurna excessiva nesses pacientes. Métodos: Estudo transversal com 113 pacientes (média de idade 59,7; 70,8% sexo masculino). Utilizou-se um instrumento para caracterização sociodemográfica e clínica e a Escala de Sonolência de Epworth. Resultados: A sonolência diurna excessiva foi identificada em 33 pacientes (29,2%). Aqueles com índice de massa corporal acima de 30kg/m 2 e aqueles que evoluíram com piora clínica obtiveram escore superior na Escala de Sonolência Epworth, comparados àqueles com índice de massa corporal inferior a 30kg/m 2 e melhora clínica. Os pacientes com 60 anos ou mais, os separados e aqueles com índice de massa corporal superior a 30kg/m 2 apresentaram chances maiores de referir sonolência diurna excessiva. Conclusão: Identificar indivíduos com sonolência diurna excessiva deve constituir parte da atuação rotineira do enfermeiro visando à prevenção das doenças cardiovasculares.

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Excessive Daytime Sleepiness is Associated with Longer Culprit Lesion and Adverse Outcomes in Patients with Coronary Artery Disease

Abstract: In patients presenting with coronary artery disease, excessive daytime sleepiness based on ESS > 10 was associated with longer culprit lesions and future adverse cardiovascular events.

Cited by 23 publications

References 26 publications

Excessive Daytime Sleepiness Independently Predicts Increased Cardiovascular Risk After Myocardial Infarction

Excessive Daytime Sleepiness Independently Predicts Increased Cardiovascular Risk After Myocardial Infarction

Profile of patients using nasoenteric probe at the adult emergency service in a public hospital

Sonolência diurna excessiva nos pacientes com infarto agudo do miocárdio

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