Prognostic implication of obstructive sleep apnea diagnosed by post-discharge sleep study in patients presenting with acute coronary syndrome.

OBJECTIVE: We aimed to determine the prognostic implications of obstructive sleep apnea (OSA) diagnosed during the recovery phase of acute coronary syndrome (ACS). METHODS: Patients presenting with ACS and treated with percutaneous coronary intervention were recruited prospectively for a home-based sleep study within 30 days of hospital discharge. Major adverse cardiac and cerebrovascular events (MACCEs) assessed included cardiac death, myocardial infarction, stroke, unplanned revascularization, and hospitalization for heart failure. RESULTS: Of the 85 patients recruited, 68 successfully completed the study. The median time from percutaneous coronary intervention to sleep study was 14 days (interquartile range: 7.5-27 days). OSA was diagnosed in 24 patients (35.3%) (apnea-hypopnea index > or =15). A drug-eluting stent was implanted into the target lesion in 45 patients (66.2%). None of the study patients had received treatment for OSA. At 24-month follow-up, the MACCE incidence was 34.9% in the OSA group and 5.1% in the non-OSA group (P=0.008, log-rank test). After adjusting for the possible confounding effect of age, gender, coronary intervention indications, hypertension, smoking, and body mass index, OSA remained an independent predictor of MACCEs (adjusted hazard ratio, 6.95; 95% confidence interval, 1.17-41.4; P=0.033). CONCLUSION: OSA diagnosed in patients treated with percutaneous coronary intervention for ACS by post-discharge sleep studies conducted 2 weeks after percutaneous coronary intervention was independently associated with MACCEs at 24-month follow-up.

The influence of timing of polysomnography on diagnosis of obstructive sleep apnea in patients presenting with acute myocardial infarction and stable coronary artery disease.

BACKGROUND: We aimed to determine if timing of polysomnography (PSG) influences the diagnosis of obstructive sleep apnea (OSA) in acute myocardial infarction (AMI) or stable coronary artery disease (CAD). METHODS: A total of 160 patients admitted with AMI or stable CAD were consecutively recruited for either in-hospital (n=80) or postdischarge (n=80) PSG. RESULTS: The median time from admission to PSG for the in-hospital and postdischarge groups was 1 day and 17 days, respectively (P<.001). Overall, 59 patients (36.9%) were diagnosed with OSA (apnea-hypopnea index [AHI] > or = 15), and they were more likely to have diabetes mellitus (DM), hypertension, hyperlipidemia, chronic renal failure, and a greater body mass index (BMI) (P<.05 for all). The diagnosis of OSA was significantly higher (P=.037) in patients who had a PSG performed as an inpatient than those who had a PSG as an outpatient. There was a significant interaction between clinical presentation and the effect of PSG timing on the diagnosis of OSA (P=.003). For the patients presenting with AMI but not those with stable CAD, in-hospital PSG was an independent predictor of OSA (adjusted odds ratio, 3.84 [95% confidence interval, 1.42-10.41]; P=.008). CONCLUSION: The timing of PSG influenced the diagnosis of OSA in patients who presented with AMI but not in those who presented with stable CAD.