Outcomes in coronary artery disease patients with sleepy obstructive sleep apnoea on CPAP
- S-Med
- 4 days ago
- 2 min read
To the best of our knowledge, this is the first prospective, observational study comparing risk for MACCEs in a revascularised CAD cohort with sleepy OSA receiving CPAP treatment with risk in patients without OSA. The results showed that the risk for MACCEs in revascularised CAD patients with sleepy OSA on CPAP was similar to that in CAD patients without OSA. In a multivariate analysis, age and former revascularisation were associated with an increased risk for MACCEs, while CABG appeared to be superior to PCI for reducing the risk for subsequent MACCEs in this cohort.
Many CAD patients experience MACCEs in the years after intervention, despite advances in medical treatment and revascularisation techniques, and it has been suggested that OSA may play an important role in this context. YUMINO et al. documented MACCEs after PCI in almost 24% of patients with concomitant OSA compared with 5% of those without OSA over a 6-month follow-up. More recently, a single-centre study of 340 consecutive CAD patients treated with a drug-eluting stent reported that the incidence of a major cardiac event (MACE; new revascularisation, myocardial infarction or cardiac
mortality) over a median 2-year follow-up was 25% in patients with OSA (AHI ⩾15 events·h−1 on CRPG) compared with 16% in those with AHI <15 events·h−1 (p=0.038) and that OSA was an independent predictor of MACEs, nearly doubling the risk [5]. In a much larger cohort of CAD patients undergoing PCI [6], LEE et al. reported that 45% of 1311 patients had OSA (AHI ⩾15 events·h−1 on CRPG within 7 days after revascularisation). In this multicentre study conducted in five countries, OSA was a predictor of MACCEs over a median follow-up of almost 2 years, with an adjusted HR of 1.6 independent of age,
sex, ethnicity, BMI, diabetes mellitus and hypertension. Moreover, in a smaller study of 67 CAD patients undergoing CABG, MACCEs were observed in 35% of OSA patients (AHI ⩾15 events·h−1 on CRPG) compared with 16% in patients with AHI <15 events·h−1 (p=0.02) during a mean follow-up of 4.5 years and OSA was an independent predictor of incident MACCEs with a 4-fold risk increase in multivariate analysis.
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