Obstructive Sleep Apnea and Cardiovascular Events After Percutaneous Coronary Intervention

Chi-Hang Lee¹, Rishi Sethi², Ruogu Li², Hee-Hwa Ho², Thet Hein², Man-Hong Jim², Germaine Loo², Chieh-Yang Koo², Xiao-Fei Gao², Sharad Chandra², Xiao-Xiao Yang², Sofia F Furlan², Zhen Ge², Ajeya Mundhekar², Wei-Wei Zhang², Carlos Henrique G Uchôa², Rajiv Bharat Kharwar², Po-Fun Chan², Shao-Liang Chen², Mark Y Chan², Arthur Mark Richards², Huay-Cheem Tan², Thun-How Ong², Glenn Roldan², Bee-Choo Tai², Luciano F Drager², Jun-Jie Zhang²

Affiliations

¹ From Department of Cardiology, National University Heart Centre, Singapore (C-H.L., G.L., C.-Y.K., P.-F.C., M.Y.C., A.M.R., H.-C.T.); Department of Cardiology, King George's Medical University, Lucknow, India (R.S., S.C., A.M., R.B.K.); Department of Cardiology, Shanghai Chest Hospital, China (R.L., X.-X.Y., W.-W.Z.); Department of Cardiology, Tan Tock Seng Hospital, Singapore (H.-H.H.); No (1) 1000-Bed Defence Services General Hospital, Mingaladon, Yangon, Myanmar (T.H.); Cardiac Medical Unit, Grantham Hospital, Hong Kong (M.-H.J.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, China (X.-F.G., Z.G., S.-L.C., J.-J.Z.); Hypertension Unit-Heart Institute (InCor), University of Sao Paulo Medical School, Brazil (S.F.F., C.H.G.U., L.F.D.); Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore (T.-H.O.); Sleep Educators, Antioch, CA (G.R.); and Saw Swee Hock School of Public Health, National University of Singapore, Singapore (B.-C.T.). mdclchr@nus.edu.sg.
² From Department of Cardiology, National University Heart Centre, Singapore (C-H.L., G.L., C.-Y.K., P.-F.C., M.Y.C., A.M.R., H.-C.T.); Department of Cardiology, King George's Medical University, Lucknow, India (R.S., S.C., A.M., R.B.K.); Department of Cardiology, Shanghai Chest Hospital, China (R.L., X.-X.Y., W.-W.Z.); Department of Cardiology, Tan Tock Seng Hospital, Singapore (H.-H.H.); No (1) 1000-Bed Defence Services General Hospital, Mingaladon, Yangon, Myanmar (T.H.); Cardiac Medical Unit, Grantham Hospital, Hong Kong (M.-H.J.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, China (X.-F.G., Z.G., S.-L.C., J.-J.Z.); Hypertension Unit-Heart Institute (InCor), University of Sao Paulo Medical School, Brazil (S.F.F., C.H.G.U., L.F.D.); Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore (T.-H.O.); Sleep Educators, Antioch, CA (G.R.); and Saw Swee Hock School of Public Health, National University of Singapore, Singapore (B.-C.T.).

PMID: 27178625
DOI: 10.1161/CIRCULATIONAHA.115.019392

Clinical Trial

Obstructive Sleep Apnea and Cardiovascular Events After Percutaneous Coronary Intervention

Chi-Hang Lee et al. Circulation. 2016.

. 2016 May 24;133(21):2008-17.

doi: 10.1161/CIRCULATIONAHA.115.019392. Epub 2016 May 13.

Authors

Affiliations

¹ From Department of Cardiology, National University Heart Centre, Singapore (C-H.L., G.L., C.-Y.K., P.-F.C., M.Y.C., A.M.R., H.-C.T.); Department of Cardiology, King George's Medical University, Lucknow, India (R.S., S.C., A.M., R.B.K.); Department of Cardiology, Shanghai Chest Hospital, China (R.L., X.-X.Y., W.-W.Z.); Department of Cardiology, Tan Tock Seng Hospital, Singapore (H.-H.H.); No (1) 1000-Bed Defence Services General Hospital, Mingaladon, Yangon, Myanmar (T.H.); Cardiac Medical Unit, Grantham Hospital, Hong Kong (M.-H.J.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, China (X.-F.G., Z.G., S.-L.C., J.-J.Z.); Hypertension Unit-Heart Institute (InCor), University of Sao Paulo Medical School, Brazil (S.F.F., C.H.G.U., L.F.D.); Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore (T.-H.O.); Sleep Educators, Antioch, CA (G.R.); and Saw Swee Hock School of Public Health, National University of Singapore, Singapore (B.-C.T.). mdclchr@nus.edu.sg.
² From Department of Cardiology, National University Heart Centre, Singapore (C-H.L., G.L., C.-Y.K., P.-F.C., M.Y.C., A.M.R., H.-C.T.); Department of Cardiology, King George's Medical University, Lucknow, India (R.S., S.C., A.M., R.B.K.); Department of Cardiology, Shanghai Chest Hospital, China (R.L., X.-X.Y., W.-W.Z.); Department of Cardiology, Tan Tock Seng Hospital, Singapore (H.-H.H.); No (1) 1000-Bed Defence Services General Hospital, Mingaladon, Yangon, Myanmar (T.H.); Cardiac Medical Unit, Grantham Hospital, Hong Kong (M.-H.J.); Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, China (X.-F.G., Z.G., S.-L.C., J.-J.Z.); Hypertension Unit-Heart Institute (InCor), University of Sao Paulo Medical School, Brazil (S.F.F., C.H.G.U., L.F.D.); Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore (T.-H.O.); Sleep Educators, Antioch, CA (G.R.); and Saw Swee Hock School of Public Health, National University of Singapore, Singapore (B.-C.T.).

PMID: 27178625
DOI: 10.1161/CIRCULATIONAHA.115.019392

Abstract

Background: There is a paucity of data from large cohort studies examining the prognostic significance of obstructive sleep apnea (OSA) in patients with coronary artery disease. We hypothesized that OSA predicts subsequent major adverse cardiac and cerebrovascular events (MACCEs) in patients undergoing percutaneous coronary intervention.

Methods and results: The Sleep and Stent Study was a prospective, multicenter registry of patients successfully treated with percutaneous coronary intervention in 5 countries. Between December 2011 and April 2014, 1748 eligible patients were prospectively enrolled. The 1311 patients who completed a sleep study within 7 days of percutaneous coronary intervention formed the cohort for this analysis. Drug-eluting stents were used in 80.1% and bioresorbable vascular scaffolds in 6.3% of the patients, and OSA, defined as an apnea-hypopnea index of ≥15 events per hour, was found in 45.3%. MACCEs, a composite of cardiovascular mortality, nonfatal myocardial infarction, nonfatal stroke, and unplanned revascularization, occurred in 141 patients during the median follow-up of 1.9 years (interquartile range, 0.8 years). The crude incidence of an MACCEs was higher in the OSA than the non-OSA group (3-year estimate, 18.9% versus 14.0%; p=0.001). Multivariate Cox regression analysis indicated that OSA was a predictor of MACCEs, with an adjusted hazard ratio of 1.57 (95% confidence interval, 1.10-2.24; P=0.013), independently of age, sex, ethnicity, body mass index, diabetes mellitus, and hypertension.

Conclusions: OSA is independently associated with subsequent MACCEs in patients undergoing percutaneous coronary intervention. Evaluation of therapeutic approaches to mitigate OSA-associated risk is warranted.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01306526.

Keywords: coronary artery disease; outcome assessment (health care); percutaneous coronary intervention; risk factors; sleep apnea, obstructive.

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Comment in

Interventional cardiology: OSA predicts cardiac risk in patients undergoing PCI.
Huynh K. Huynh K. Nat Rev Cardiol. 2016 Aug;13(8):444. doi: 10.1038/nrcardio.2016.93. Epub 2016 Jun 3. Nat Rev Cardiol. 2016. PMID: 27256214 No abstract available.
Obstructive Sleep Apnea and Cardiovascular Disease.
Perger E, Gonzaga-Carvalho C, Inami T, Ryan CM, Lyons OD. Perger E, et al. Am J Respir Crit Care Med. 2019 Feb 1;199(3):377-379. doi: 10.1164/rccm.201709-1875RR. Am J Respir Crit Care Med. 2019. PMID: 30433816 No abstract available.

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Obstructive Sleep Apnea and Cardiovascular Events After Percutaneous Coronary Intervention

Affiliations

Obstructive Sleep Apnea and Cardiovascular Events After Percutaneous Coronary Intervention

Authors

Affiliations

Abstract

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Medical

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