Obstructive Sleep Apnea and Diabetes Independently Add to Cardiovascular Risk After Coronary Revascularization

Obstructive sleep apnea (OSA) has been shown to be associated with accelerated coronary atherosclerosis (1–3). In the multicenter Sleep and Stent Study, we found that OSA was an independent predictor of major adverse cardiac and cerebrovascular events (MACCE) and cardiovascular mortality after percutaneous coronary intervention (PCI), with adjusted hazard ratios (HR) of 1.57 (95% CI 1.10–2.24) and 2.11 (95% CI 0.91–4.91), respectively (4). Diabetes mellitus (DM) is an established risk factor of MACCE after PCI and was present in 42% of the patients in the Sleep and Stent Study (4). In this post hoc analysis, we hypothesized that patients with combined OSA and DM were at a particularly high risk of developing MACCE after PCI. The Sleep and Stent Study was an observational study evaluating the effects of OSA on cardiovascular outcomes in patients undergoing PCI. The detailed methodology and inclusion and exclusion criteria have been published previously (5). After an overnight sleep study, the recruited patients were classified as OSA(+) (apnea-hypopnea index ≥15 events per hour) or OSA(−) (<15 events per hour). Studies have suggested the possible interaction between DM and OSA in glycemic control and the progression of chronic diabetic complications (6–8). As such, the primary aim of this post hoc analysis was to determine whether the effects of OSA in the occurrence of cardiovascular outcomes, defined as MACCE composed of cardiovascular mortality, nonfatal myocardial infarction, or nonfatal stroke, may be modified …