Glaucylara Reis Geovanini

OSA and Depression Are Common and Independently Associated With Refractory Angina in Patients With Coronary Artery Disease

OBJECTIVE Refractory angina is a severe form of coronary artery disease (CAD) characterized by persistent angina despite optimal medical therapy. OSA and depression are common in patients with stable CAD and may contribute to a poor prognosis. We hypothesized that OSA and depression are more common and more severe in patients with refractory angina than in patients with stable CAD. METHODS We used standardized questionnaires and full polysomnography to compare consecutive patients with well-established refractory angina vs consecutive patients with stable CAD evaluated for coronary artery bypass graft surgery. RESULTS Patients with refractory angina (n = 70) compared with patients with stable CAD (n = 70) were similar in sex distribution (male, 61.5% vs 75.5%; P = .07) and BMI (29.5 ± 4 kg/m2 vs 28.5 ± 4 kg/m2, P = .06), and were older (61 ± 10 y vs 57 ± 7 y, P = .013), respectively. Patients with refractory angina had significantly more symptoms of daytime sleepiness (Epworth Sleepiness Scale score, 12 ± 6 vs 8 ± 5; P < .001), had higher depression symptom scores (Beck Depression Inventory score, 19 ± 8 vs 10 ± 8; P < .001) despite greater use of antidepressants, had a higher apnea-hypopnea index (AHI) (AHI, 37 ± 30 events/h vs 23 ± 20 events/h; P = .001), higher proportion of oxygen saturation < 90% during sleep (8% ± 13 vs 4% ± 9, P = .04), and a higher proportion of severe OSA (AHI ≥ 30 events/h, 48% vs 27%; P = .009) than patients with stable CAD. OSA (P = .017), depression (P < .001), higher Epworth Sleepiness Scale score (P = .007), and lower sleep efficiency (P = .016) were independently associated with refractory angina in multivariate analysis. CONCLUSIONS OSA and depression are independently associated with refractory angina and may contribute to poor cardiovascular outcome.

Obstructive sleep apnoea is associated with myocardial injury in patients with refractory angina

Objective To investigate the association between obstructive sleep apnoea (OSA) severity with markers of overnight myocardial injury in patients with refractory angina. Methods Patients with refractory angina were characterised clinically and they underwent ischaemia imaging stress tests by single-photon emission computed tomography (SPECT) and/or cardiac MRI. The patients were admitted to the hospital, remained under resting conditions for blood determination of high-sensitivity cardiac troponin T (hs-cTnT) at 14:00, 22:00 and after overnight polysomnography at 7:00. Results We studied 80 consecutive patients (age: 62±10 years; male: 66%; body mass index (BMI): 29.5±4 kg/m2) with well-established diagnosis of refractory angina. The mean apnoea–hypopnoea index (AHI) was 37±29 events/h and OSA (AHI >15 events/h) was present in 75% of the population. Morning detectable hs-cTnT and above 99th percentile was present in 88% and 36% of the population, respectively. Patients in the first to third quartiles of OSA severity did not have circadian variation of hs-cTnT. In contrast, patients in the fourth quartile (AHI ≥51 events/h) had a circadian variation of hs-cTnT with a morning peak of hs-cTnT that was two times higher than that in the remaining population (p=0.02). The highest quartile of OSA severity remained associated with the highest quartile of hs-cTnT (p=0.028) in multivariate analysis. Conclusion Very severe OSA is common and independently associated with overnight myocardial injury in patients with refractory angina.

Association between Obstructive Sleep Apnea and Cardiovascular Risk Factors: Variation by Age, Sex, and Race. The Multi-Ethnic Study of Atherosclerosis

Rationale: The association between obstructive sleep apnea (OSA) and cardiovascular disease (CVD) is complex, bidirectional, and may vary across groups. Understanding which cardiovascular risk factors vary in their relationship to OSA across population groups may improve knowledge of OSA‐related CVD susceptibility. Objectives: To better understand the heterogeneity of associations, we assessed whether associations of OSA with cardiovascular risk factors vary by age, sex, and race/ethnicity. Methods: We performed cross‐sectional analyses of 1,344 Multi‐Ethnic Study of Atherosclerosis participants who underwent overnight full polysomnography, assays of fasting blood, and assessments of cardiovascular risk factors. Risk factors considered were blood pressure, glucose/lipid concentrations, white blood cell (WBC) total and subset counts, and cystatin C. The outcome was the apnea‐hypopnea index (AHI). Linear regression analyses with tests for interactions were conducted. Results: The sample had a mean age of 68 ± 9 years. Forty‐seven percent of the sample was male, and 32% had moderate or severe OSA (AHI, ≥15). Multivariable adjusted analysis showed significant associations between higher AHI with lower high‐density lipoprotein cholesterol and higher diastolic blood pressure and neutrophil counts. Significant interactions with demographic factors were observed. Stronger associations were shown between AHI and higher total WBC count (Pint = 0.006) and glucose concentrations (Pint = 0.006) in younger (<65 yr) than in older individuals, higher triglyceride concentrations in men than in women (Pint = 0.006), and higher total WBC (Pint = 0.07) and monocyte counts (Pint = 0.03) in African American individuals than in other racial groups. Conclusions: In a multiethnic cohort, we found increased levels of cardiovascular risk factors in association with OSA, including elevated neutrophil counts, a marker of inflammation. Furthermore, several associations were stronger in men, younger individuals, and African American individuals, highlighting pathways for CVD risk that may explain heterogeneity in the associations between CVD and OSA across population groups.

OSA and Prognosis After Acute Cardiogenic Pulmonary Edema: The OSA-CARE Study

BACKGROUND: Acute cardiogenic pulmonary edema (ACPE) is a life‐threatening condition. OSA may be a modifiable risk factor for ACPE recurrence. This study was designed to evaluate the impact of OSA on the incidence of cardiovascular events following ACPE recovery. METHODS: Consecutive patients with confirmed ACPE from 3 centers underwent a sleep study following clinical stabilization. OSA was defined as an apnea‐hypopnea index (AHI) ≥ 15 events/h. The mean follow‐up was 1 year, and the primary outcome was ACPE recurrence. RESULTS: A total of 104 patients were included in the final analysis; 61% of the patients had OSA. A higher rate of ACPE recurrence (25 vs 6 episodes; P = .01) and a higher incidence of myocardial infarction (15 vs 0 episodes; P = .0004) were observed in patients with OSA than in those without OSA. All 17 deaths occurred in the OSA group (P = .0001). In a Cox proportional hazards regression analysis, OSA was independently associated with ACPE recurrence (hazard ratio [HR], 3.3 [95% CI, 1.2–8.8]; P = .01), incidence of myocardial infarction (HR, 2.3 [95% CI, 1.1–9.5]; P = .02), cardiovascular death (HR, 5.4 [95% CI, 1.4–48.4]; P = .004), and total death (HR, 6.5 [95% CI, 1.2–64.0]; P = .005). When the analysis was limited only to patients with OSA, levels of AHI and hypoxemic burden and rates of sleep‐onset ACPE were significantly higher in those who presented with ACPE recurrence or who died than in those who did not experience these events. CONCLUSIONS: OSA is independently associated with higher rates of ACPE recurrence and both fatal and nonfatal cardiovascular events.

A APNEIA OBSTRUTIVA DO SONO ESTÁ ASSOCIADA COM MAIOR MORBIDADE E MORTALIDADE CARDIOVASCULAR EM PACIENTES COM EDEMA AGUDO DOS PULMÕES CARDIOGÊNICO

Durante o período de 2 anos, recrutamos casos consecutivos de EAP nas Unidades de Emergências de três centros terciários de Cardiologia. Após o tratamento de rotina para o EAP e estabilização clínica, todos os pacientes que sobreviveram ao evento foram convidados a realizar a monitorização portátil do sono (Embletta GoldTM). A AOS foi definida por um índice de apneia e hipopneia Z15 eventos/hora. Realizamos o seguimento dos pacientes em busca de eventos cardiovasculares adotando critérios padronizados. O nosso objetivo primário foi o de avaliar a frequência de ocorrência de novo EAP.