Sleep apnea prevalence in acute myocardial infarction — The Sleep Apnea in Post-acute Myocardial Infarction Patients (SAPAMI) Study

Abstract

Background While sleep apnea (SA) might be a modifiable cardiovascular risk factor, recent data suggest that SA is severely underdiagnosed in patients after acute myocardial infarction (MI). There is limited evidence about day-night variation of onset of MI on dependence of having SA. We therefore investigated the prevalence of SA and examined the day-night variation of onset of MI in acute MI patients. Methods We prospectively studied 782 consecutive patients admitted to the hospital with the diagnosis of acute MI. All subjects underwent sleep evaluations using a portable device after at least 48 hours post-admission. Using the apnea-hypopnea index (AHI), groups were defined as patients without SA (<5 events/hour), mild SA (5–15 events/hour), moderate SA (15–30 events/hour), and severe SA (≥30 events/hour). Results Almost all patients (98%) underwent urgent coronary angiography and 91% of patients underwent primary PCI. Using a threshold of AHI ≥ 5 events/hour, SA was present in 65.7% of patients after acute MI. Mild SA was present in 32.6%, moderate in 20.4% and severe in 12.7%. The day-night variation in the onset of MI in all groups of SA patients was similar to that observed in non-SA patients. From 6AM–12PM, the frequency of MI was higher in both SA and non-SA patients, as compared to the interval from 12AM–6AM (all p<0.05). Conclusion There is a high prevalence of SA in patients presenting with acute MI. Peak time of MI onset in SA patients was between 6AM–noon, similar to that in the general population. Whether diagnosis and treatment of SA after MI will significantly improve outcomes in these patients remains to be determined.

The relationship between apnoea hypopnoea index and Gensini score in patients with acute myocardial infarction undergoing emergency primary percutaneous coronary intervention

“…Ben Ahmend et al (22) reported a 79% prevalence of OSAHS with AMI for 120 people in France. Ludka et al (10) reported a 65.7% prevalence in Brno, Czech Republic. In comparison with the prevalence of SAHS in CAD (approximately 60%), that in AMI undergoing emergency pPCI is much higher.…”

“…Findings from published reports present that the prevalence of SAHS among patients with AMI is up to 60% (10), which is mostly ignored by physicians on the cardiac intensive care unit (CCU), not to mention treatment. Some studies about the effect of SAHS on AMI showed that SAHS would worsen the condition in patients with AMI.…”

Response to the Letter of Dr. Tomoyuki Kawada, “Acute Myocardial Infarction and Sleep Apnea”

“…Therefore, we used the overall apnea-hypopnea index, without specific subanalysis for obstructive and central events. Indeed, we specifically note the inability to discriminate between obstructive and central events as a significant limitation of our study [1].…”

“…We thank Dr. Kuwada for the comments related to our study [1] and are pleased to provide specific answers below.…”

Acute myocardial infarction and sleep apnea

“…To the Editor: I read the study by Ludka et al with interest [1]. The authors investigated the prevalence of sleep apnea (SA) and examined the daynight variation of onset of myocardial infarction (MI) in 607 acute MI patients.…”