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. 2025 Jan 15;26(1):25814.
doi: 10.31083/RCM25814. eCollection 2025 Jan.

Impact of Obstructive Sleep Apnea on In-Stent Restenosis in Coronary Heart Disease Patients after Elective Drug-Eluting Stenting

Wenjie Yang  1 , Zhuoshan Huang  1 , Ke Yang  1 , Dinghui Liu  1 , Junpeng Xiao  1 , Zhen Wu  1 , Ling Jiang  1 , Shan Cao  1 , Xujing Xie  1 , Shujie Yu  1
Affiliations

Impact of Obstructive Sleep Apnea on In-Stent Restenosis in Coronary Heart Disease Patients after Elective Drug-Eluting Stenting

Wenjie Yang et al. Rev Cardiovasc Med. .

Abstract

Background: Extensive research has established obstructive sleep apnea (OSA) as a contributing factor to numerous cardiovascular and cerebrovascular diseases. However, whether OSA affects in-stent restenosis (ISR) after elective drug-eluting stenting is unclear. Therefore, the objective of this study was to examine the impact of OSA on ISR in patients with coronary heart disease (CHD) who underwent successful elective drug-eluting stent (DES) implantation.

Methods: This study retrospectively analyzed CHD patients who successfully underwent elective coronary stent implantation and overnight sleep breathing monitoring and were readmitted for coronary angiography due to symptoms of CHD at 12 to 26 months after percutaneous coronary intervention (PCI). OSA was diagnosed when the apnea-hypopnea index (AHI) was ≥5 events/hour. ISR was defined as >50% restenosis of the vessel diameter in which the DES was implanted. To explore the association between OSA and ISR among patients with CHD, multivariate logistic regression models were developed and utilized.

Results: This study enrolled 206 individuals who were diagnosed with CHD, with a mean age of 62.01 ± 10.27 years, and males constituted 76.2% of the patient population. After a median follow-up period of 15 months following DES implantation, there was a significant increase in the incidence of ISR among patients with moderate to severe OSA, increasing from 10.9% to 31.3% (p < 0.001). According to the fully adjusted model, the occurrence of ISR was found to be independently associated with the presence of OSA (OR: 3.247, 95% CI: 1.373-7.677, p = 0.007).

Conclusions: In individuals who underwent elective drug-eluting stenting, OSA is an independent risk factor for ISR.

Keywords: drug-eluting stent; in-stent restenosis; obstructive sleep apnea.

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Conflict of interest statement

Dinghui Liu reports financial support was provided by Natural Science Foundation of Guangdong Province of China. If there are other authors, the authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1.
Fig. 1.
Impact of the AHI on the incidence of DES-ISR (A) and a comparison of the AHI between the ISR and non-ISR groups (B). AHI, apnea-hypopnea index; ISR, in-stent restenosis; DES, drug-eluting stent.
Fig. 2.
Fig. 2.
The comparison of the total percentage of time of SaO2 <90% (A), minimal SaO2 (B), and mean SaO2 (C) level between the ISR and non-ISR groups in the overall study population. ISR, in-stent restenosis.
Fig. 3.
Fig. 3.
Impact of OSA on the incidence of ISR in subgroups stratified by sex (A), age (B), BMI (C), diabetes status (D), eGFR (E), and number of stents (F). ISR, in-stent restenosis; AHI, apnea-hypopnea index; BMI, body mass index; eGFR, estimated glomerular filtration rate; OSA, obstructive sleep apnea.
Fig. 4.
Fig. 4.
Forest plot of the multivariable logistic regression analysis model investigating the association between OSA and ISR. OSA, obstructive sleep apnea; ISR, in-stent restenosis; LDL-C, low density lipoprotein cholesterol; BMI, body mass index; OR, odds ratio; CI, confidence interval.
Fig. 5.
Fig. 5.
Forest plot investigating the association between OSA and ISR in subgroup analysis. OSA, obstructive sleep apnea; ISR, in-stent restenosis; BMI, body mass index; eGFR, estimated glomerular filtration rate; OR, odds ratio; CI, confidence interval.
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