Central Sleep Apnoea and Arrhythmogenesis After Myocardial Infarction-The CESAAR Study.

Alexander Reshetnik,Swetlana Puppe,Hendrik Bonnemeier

doi:10.3389/fcvm.2019.00108

Abstract

The prevalence of sleep disordered breathing (SDB) after acute myocardial infarction (AMI) is high. However, little is known about predominant SDB type and the impact of SDB severity on arrhythmogenesis. We conducted a prospective single-center observational study and performed an unattended sleep study and Holter monitoring within 10 days after AMI, and an unattended sleep study 11.3 months after AMI. All patients were included from the Department of Cardiology at the University Hospital Schleswig-Holstein, Lübeck, Germany. A total of 202 subjects with AMI (73.8% with ST-elevation; 59.8 years; 73.8% male) were included. The mean BMI was 27.8 kg/m2 and the mean neck/waist circumference was 41.7/103.3 cm. The mean left ventricular ejection fraction was 56.6%. The SDB prevalence defined as apnoea-hypopnea-index (AHI) ≥ 5/h was 66.7% with 44.9% having central (CSA), and 21.8% obstructive sleep apnoea (OSA). The mean AHI was 13.8 1/h. In 10.2% nsVT was detected in the Holter monitoring. AI >23/h was independently associated with higher risk of nsVT in the subacute AMI period. SDB is highly prevalent and CSA a predominant type of SDB in the subacute phase after uncomplicated AMI treated with modern revascularization procedures and evidence-based pharmacological therapy. Severe SDB is independently associated with higher risk for nsVT in the subacute AMI period and its course should be monitored as it can potentially have a negative impact on relevant outcomes of AMI patients. Further prospective studies are needed to assess long-term follow up of SDB after AMI and its impact on mortality and morbidity.

Highlights

Ischemic heart disease is one of the major causes of death worldwide
We considered subjects having Central sleep apnoea (CSA) when more than 50% of apnoea events were classified as central or having obstructive sleep apnoea (OSA), when more than 50% of apnoea events were classified as obstructive according to Academy of Sleep Medicine (AASM) criteria
We found high prevalence of sleep-disordered breathing (SDB) in the subacute phase after uncomplicated acute myocardial infarction (AMI), which was markedly increased compared to the general population [23]

Summary

Introduction

Ischemic heart disease is one of the major causes of death worldwide. Introduction and widespread use of modern revascularization procedures and evidence-based pharmacological therapy improved the long-term prognosis after acute myocardial infarction (AMI) significantly [1, 2]. Central sleep apnoea (CSA) is a type of SDB common in patients with congestive heart failure [10,11,12]. Several pathophysiological changes such as pulmonary congestion, impaired autonomic function, and sympathetic hyperactivity, which occur after AMI, are known causes of CSA [13, 14]. We conducted a prospective single-center study to observe the prevalence of SDB and CSA in particular in the subacute phase of AMI and to assess the impact of SDB severity on the prevalence of non-sustained ventricular tachycardia (nsVT) as a known predictor of sudden cardiac death in post-infarct patients [17, 18]

Methods

Results

Discussion

Conclusion