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. 2018 Feb;153(2):329-338.
doi: 10.1016/j.chest.2017.06.046. Epub 2017 Jul 20.

Cardiac Troponin Values in Patients With Acute Coronary Syndrome and Sleep Apnea: A Pilot Study

Alicia Sánchez-de-la-Torre  1 , Xavier Soler  2 , Ferran Barbé  1 , Marina Florés  3 , Alan Maisel  4 , Atul Malhotra  2 , Montserrat Rue  5 , Sandra Bertran  5 , Albina Aldomá  6 , Fernando Worner  6 , Joan Valls  5 , Chi-Hang Lee  7 , Cecilia Turino  1 , Estefanía Galera  3 , Jordi de Batlle  1 , Manuel Sánchez-de-la-Torre  8 ; Spanish Sleep Network(∗)
Collaborators, Affiliations

Cardiac Troponin Values in Patients With Acute Coronary Syndrome and Sleep Apnea: A Pilot Study

Alicia Sánchez-de-la-Torre et al. Chest. 2018 Feb.

Abstract

Background: An analysis of cardiac injury markers in patients with OSA who sustain an episode of acute coronary syndrome (ACS) may contribute to a better understanding of the interactions and impact of OSA in subjects with ACS. We compared peak cardiac troponin I (cTnI) levels in patients with OSA and patients without OSA who were admitted for ACS.

Methods: Blood samples were collected every 6 hours from the time of admission until two consecutive assays showed a downward trend in the cTnI assay. The highest value obtained defined the peak cTnI value, which provides an estimate of infarct size.

Results: We included 89 patients with OSA and 38 patients without OSA with an apnea-hypopnea index of a median of 32 (interquartile range [IQR], 20.8-46.6/h and 4.8 [IQR, 1.6-9.6]/h, respectively. The peak cTnI value was significantly higher in patients without OSA than in patients with OSA (median, 10.7 ng/mL [IQR, 1.78-40.1 ng/mL] vs 3.79 ng/mL [IQR, 0.37-24.3 ng/mL]; P = .04). The multivariable linear regression analysis of the relationship between peak cTnI value and patient group, age, sex, and type of ACS showed that the presence or absence of OSA significantly contributed to the peak cTnI level, which was 54% lower in patients with OSA than in those without OSA.

Conclusions: The results of this study suggest that OSA has a protective effect in the context of myocardial infarction and that patients with OSA may experience less severe myocardial injury. The possible role of OSA in cardioprotection should be explored in future studies.

Keywords: ACS; OSA; cardiac biomarkers; cardiovascular disease; management; troponin.

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Figures

Figure 1
Figure 1
Flowchart of study recruitment. ESS = Epworth Sleepiness Scale; RP = respiratory polygraphy.
Figure 2
Figure 2
Box plots of peak cardiac troponin I levels in patients with and those without OSA. P values were obtained using the Mann-Whitney test.
Figure 3
Figure 3
Box plots of the area under the cardiac troponin I curve in patients with and those without OSA. P values were obtained using the Mann-Whitney test.
Figure 4
Figure 4
Box plots of peak cardiac troponin I levels in patients without OSA or with mild to moderate or severe OSA. The severity of OSA was based on the apnea-hypopnea index. P values were obtained using the Mann-Whitney and Kruskal-Wallis tests.
Figure 5
Figure 5
Box plots of the area under the cardiac troponin I curve in patients without OSA or with mild to moderate or severe OSA. The severity of obstructive apnea was based on the apnea-hypopnea index. P values were obtained using the Mann-Whitney and Kruskal-Wallis tests.
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