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Sleep-disordered breathing impacts long-term outcomes for patients with ACS post-PCI
The presence of sleep-disordered breathing among patients with ACS after primary PCI has been linked with increased incidence of major adverse cardiocerebrovascular events during long-term follow-up.
Researchers evaluated 241 consecutive patients with ACS who underwent primary PCI with bare-metal stents at Kokura Memorial Hospital in Japan between January 2005 and December 2008. Each patient had an overnight sleep study using a portable cardiorespiratory monitoring device (Pulsleep LS100, Fukuda Denshi Co, Ltd.) during hospitalization approximately 1 week after ACS onset.
“Although a few studies have suggested that sleep-disordered breathing is [a factor that might contribute to worsening of clinical outcomes], the relationship between sleep-disordered breathing and long-term clinical outcomes following ACS has not been fully evaluated,” Toru Mazaki, MD, from the department of cardiology, Kobe Central Hospital, Japan, and colleagues wrote in the Journal of the American Heart Association.
For this study, sleep-disordered breathing was defined as apnea-hypopnea index (AHI) five events per hour, apnea was defined as an interruption of airflow for 10 seconds and hypopnea was defined as a 50% increase in airflow related to 4% desaturation.
Overall, 126 patients had sleep-disordered breathing and 115 did not.
During a median follow-up of 5.6 years, the primary endpoint of major adverse cardiocerebrovascular events (MACCE), including all-cause death, ACS recurrence, nonfatal stroke and hospitalization for congestive HF, occurred in 21.4% of the group with sleep-disordered breathing vs. 7.8% of the group without sleep-disordered breathing (P = .006). The most common cause of MACCE in this cohort was hospitalization for congestive HF.
Cumulative event-free survival in the entire cohort was significantly lower among patients with sleep-disordered breathing compared with those without sleep-disordered breathing.
“Furthermore, results of tests for subgroup-[sleep-disordered breathing] effect interaction suggested that the sleep-disordered breathing effect on MACCE was not different across subgroups,” the researchers wrote.
The presence of sleep-disordered breathing was a significant predictor of MACCE (HR = 2.28; 95% CI, 1.06-4.92).
“It appears that detecting sleep-disordered breathing should be included into the routine clinical care of hospitalized patients following ACS events and primary PCI. ... Nevertheless, because of the limited awareness of sleep-disordered breathing among cardiologists caring for hospitalized patients following ACS and limited access to and the relatively high cost of in-laboratory polysomnography, only a minority of ACS patients benefit from the identification of sleep-disordered breathing. It should be noted that portable cardiorespiratory monitoring, which provides a readily available and inexpensive means of detecting sleep-disordered breathing, has a prognostic impact on long-term clinical outcomes,” Mazaki and colleagues wrote. – by Jennifer Byrne
Disclosure : One researcher reports an affiliation with a department endowed by Philips Respironics, ResMed, Teijin Home Healthcare and Fukuda Denshi Co, Ltd.