Abstract
RationaleThere is growing evidence that obstructive sleep apnea is associated with coronary artery disease. However, there are no data on the course of coronary stenosis after percutaneous coronary intervention in patients with obstructive sleep apnea.ObjectivesTo determine whether sleep apnea is associated with increased late lumen loss and restenosis after percutaneous coronary intervention.Methods78 patients with coronary artery disease who underwent elective percutaneous coronary intervention were divided in 2 groups: 43 patients with an apnea hypopnea – Index < 10/h (group I) and 35 pt. with obstructive sleep apnea and an AHI > 10/h (group II). Late lumen loss, a marker of restenosis, was determined using quantitative coronary angiography after 6.9 ± 3.1 months.Main resultsAngiographic restenosis (>50% luminal diameter), was present in 6 (14%) of group I and in 9 (25%) of group II (p = 0.11). Late lumen loss was significant higher in pt. with an AHI > 10/h (0.7 ± 0.69 mm vs. 0.38 ± 0.37 mm, p = 0.01). Among these 35 patients, 21(60%) used their CPAP devices regularly. There was a marginally lower late lumen loss in treated patients, nevertheless, this difference did not reach statistical significance (0.57 ± 0.47 mm vs. 0.99 ± 0.86 mm, p = 0.08). There was no difference in late lumen loss between treated patients and the group I (p = 0.206).ConclusionIn summary, patients with OSA and coronary artery disease have a higher degree of late lumen loss, which is a marker of restenosis and vessel remodeling after elective percutaneous intervention.
Highlights
Obstructive sleep apnea (OSA) is a common disorder defined by upper airway obstruction, apnea and nocturnal hypoxia
Analysis of quantitative angiographic variables showed, that the severity of the coronary stenosis (per cent diameter stenosis before the intervention (r = -0.385, p = 0.001) and immediately after the procedure (r = 0.674, p = 0.001)) was positively correlated with late lumen loss, indicating, that severity of vessel injury is a promotor of restenosis
There was a high prevalence of cardiovascular risk factors
Summary
Obstructive sleep apnea (OSA) is a common disorder defined by upper airway obstruction, apnea and nocturnal hypoxia. There is a prevalence of OSA in patients with coronary artery disease of up to 50% [1,2,3]. Beyond this high prevalence, the occurrence of OSA is associated with an advanced state of atherosclerosis [4] and a worse prognosis in these patients [5,6,7]. Percutaneous transluminal coronary angioplasty (PTCA) has proved effective in reducing myocardial ischemia and clinical symptoms in patients with coronary artery disease (CAD) with a primary success rate ranging from 90%– 95% in the general population. Hemodynamic restenosis occurs after a period of about 12 Weeks in 30–45% of the cases treated with PTCA [8,9] and 20–30% of the cases with additional coronary stent implantation using bare metal stents [10]
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