Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Sep 1;35(9):1241-5A.
doi: 10.5665/sleep.2078.

Obstructive sleep apnea affects hospital outcomes of patients with non-ST-elevation acute coronary syndromes

Luis C L Correia  1 , Alexandre C Souza, Guilherme Garcia, Michael Sabino, Mariana Brito, Mayara Maraux, Márcia M N Rabelo, J Péricles Esteves
Affiliations

Obstructive sleep apnea affects hospital outcomes of patients with non-ST-elevation acute coronary syndromes

Luis C L Correia et al. Sleep. .

Abstract

Study objective: We aimed to test the hypothesis that clinically suspected obstructive sleep apnea (OSA) independently predicts worse in-hospital outcome in patients with non-ST elevation acute coronary syndromes.

Design: At admission, individuals were evaluated for clinical probability of OSA by the Berlin Questionnaire. Primary cardiovascular endpoint was defined as the composite of death, nonfatal myocardial infarction, or refractory angina during hospitalization.

Setting: Coronary care unit.

Patients: There were 168 consecutive patients admitted with unstable angina or non-ST elevation acute myocardial infarction.

Measurements and results: During a median hospitalization of 8 days, the incidence of cardiovascular events was 13% (12 deaths, 4 nonfatal myocardial infarctions, and 6 refractory anginas.) Incidence of the primary endpoint was 18% in individuals with high probability of OSA, compared with no events in individuals with low probability (P = 0.002). After logistic regression adjustment for the Global Registry of Acute Coronary Events (GRACE) risk score, anatomic severity of coronary disease, and hospital treatment, probability of OSA remained an independent predictor of events (odds ratio [OR] = 3.4; 95% confidence interval [CI] = 1.3 - 9.0; P = 0.015). Prognostic discrimination of the GRACE score, measured by a C-statistic of 0.72 (95% CI = 0.59-0.85), was significantly improved to 0.82 (95% CI = 0.73-0.92) after inclusion of OSA probability in the predictive model (P = 0.03).

Conclusion: Considering the independent prognostic and incremental value of suspected OSA, this condition may represent an aggravating factor for patients with non-ST elevation acute coronary syndrome.

Keywords: Acute coronary syndromes; myocardial infarction; obstructive sleep apnea; prognosis; unstable angina.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Incidence of the primary end-point according to the number of positive categories in the Berlin Questionnaire.
Figure 2
Figure 2
Comparison of the area under the ROC curve of the GRACE Score versus the GRACE-OSA Score, as predictors of the primary end-point. GRACE-OSA is the result of OSA incorporation into the GRACE as the final model in logistic regression analysis.
See this image and copyright information in PMC

References

    1. Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council On Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health) Circulation. 2008;118:1080–111. - PubMed
    1. Mooe T, Franklin KA, Holmstrom K, Rabben T, Wiklund U. Sleep-disordered breathing and coronary artery disease: long-term prognosis. Am J Respir Crit Care Med. 2001;164:1910–3. - PubMed
    1. Braunwald E, Jones RH, Mark DB, Brown J, Brown L, Cheitlin MD, et al. Diagnosing and managing unstable angina. Circulation. 1994;90:613–22. - PubMed
    1. Apple FS, Pearce LA, Smith SW, Kaczmarek JM, Murakami MM. Role of monitoring changes in sensitive cardiac troponin I assay results for early diagnosis of myocardial infarction and prediction of risk of adverse events. Clin Chem. 2009;55:930–7. - PubMed
    1. Apple FS, Quist HE, Doyle PJ, Otto AP, Murakami MM. Plasma 99th percentile reference limits for cardiac troponin and creatine kinase MB mass for use with European Society of Cardiology/American College of Cardiology Consensus Recommendations. Clin Chem. 2003;49:1331–6. - PubMed