Obstructive sleep apnea increases heart rhythm disorders and worsens subsequent outcomes in elderly patients with subacute myocardial infarction.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute myocardial infarction (n=252). Intervention: Obstructive sleep apnea combined with hypoxia vs. No obstructive sleep apnea or no hypoxia. Primary outcome: Major adverse cardiac and cerebrovascular events (MACCEs) (HR 4.536, 95% CI 1.461-14.084, p=0.009).

Ling-Jie Wang; Lina Pan; Renyu Yan; Weiwei Quan; Zhihong Xu

doi:10.11909/j.issn.1671-5411.2021.01.002

January 28, 2021Open Access

Obstructive sleep apnea increases heart rhythm disorders and worsens subsequent outcomes in elderly patients with subacute myocardial infarction.

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Key result

Obstructive sleep apnea combined with hypoxia independently increased the risk of major adverse cardiovascular and cerebrovascular events in elderly patients with subacute myocardial infarction (HR 4.536).

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Why the study?

Obstructive sleep apnea is a potential cardiovascular risk, but its association with heart rhythm disorders and prognosis in elderly patients with new-onset acute myocardial infarction required investigation.

Does obstructive sleep apnea increase heart rhythm disorders and worsen outcomes in elderly patients with subacute myocardial infarction?

Study Design

Type

Cohort (n=252)

Multicenter

No

Structured PICO

Does obstructive sleep apnea increase heart rhythm disorders and worsen outcomes in elderly patients with subacute myocardial infarction?

P

Population

252 elderly patients (aged ≥60 years) with acute myocardial infarction who underwent revascularization and a sleep study, followed for a median of 6 months.

E

Exposure

Obstructive sleep apnea (OSA) defined as an apnea-hypopnea index (AHI) ≥ 15/h, assessed via overnight sleep study within 7 days after MI.

C

Comparator

Non-OSA group defined as an apnea-hypopnea index (AHI) < 15/h.

O

Outcome

Major adverse cardiovascular and cerebrovascular events (MACCEs), defined as a composite of cardiovascular death, MI, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure, at a median follow-up of 0.8 years.composite

Main Result

Hazard Ratio: 4.536 (95% CI 1.461–14.084)

Absolute Event Rate: 19.7% vs 10.7%

p-value: p=0.009

Limitations

Use of type III portable sleep monitors may underestimate AHI values compared with the gold standard of polysomnography.
Exclusion of unstable patients who could not tolerate the sleep study may conceal the true influence of OSA on more severe cases.
Relatively small sample size from a single medical center.
Sleep studies were performed using type III portable sleep monitors, which may underestimate AHI values compared with polysomnography.
Only recruited stable subacute MI patients who could tolerate the sleep study, which may conceal the real influence of OSA on more severe patients complicated with heart failure, severe kidney diseases, or infection.
Small sample size.
Single-center study.

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Implication

OSA with hypoxia was associated with higher MACCEs in elderly post-MI patients; hypothesis-generating for future intervention trials.

Abstract

OBJECTIVE: Obstructive sleep apnea (OSA) is a potential cardiovascular risk. We aimed to investigate the association of OSA with heart rhythm disorders and prognosis in elderly patients with new-onset acute myocardial infarction (AMI). METHODS: = 122) groups based on the AHI. The changes in the autonomic nervous system, incidence of arrhythmia during nocturnal sleep, and major adverse cardiovascular and cerebrovascular events (MACCEs) were compared between the groups. CONCLUSIONS: OSA and OSA-induced hypoxia may correlate with the severity of myocardial infarction, increase the occurrence of heart rhythm disorders in elderly subacute MI patients, and worsen their short-term poor outcomes.

Discussion

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Cite This Study

Wang et al. (2021) conducted a cohort in Acute myocardial infarction (n=252). Obstructive sleep apnea combined with hypoxia vs. No obstructive sleep apnea or no hypoxia was evaluated on Major adverse cardiac and cerebrovascular events (MACCEs) (HR 4.536, 95% CI 1.461-14.084, p=0.009). Obstructive sleep apnea combined with hypoxia independently increased the risk of major adverse cardiovascular and cerebrovascular events in elderly patients with subacute myocardial infarction (HR 4.536).

synapsesocial.com/papers/6a89a3b54de818ad79d443e9 https://doi.org/10.11909/j.issn.1671-5411.2021.01.002

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Obstructive sleep apnea increases heart rhythm disorders and worsens subsequent outcomes in elderly patients with subacute myocardial infarction.

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Obstructive sleep apnea increases heart rhythm disorders and worsens subsequent outcomes in elderly patients with subacute myocardial infarction.

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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