Ischemic Pre-Conditioning is Present in Patients with Non-ST Elevation Myocardial Infarction and ECG Derived Moderate Obstructive Sleep Apnea.

Abstract

Obstructive Sleep Apnea (OSA) is associated with an increased risk of cardiovascular events, including Acute Coronary Syndrome (ACS). There is conflicting evidence that suggests OSA has a cardioprotective effect (i.e., lower troponin), via ischemic pre-conditioning, in patients with ACS. This study had two aims: (1) compare peak troponin between non-ST elevation (NSTE) ACS patients with and without moderate OSA identified using a Holter derived respiratory disturbance index (HDRDI); and (2) determine the frequency of transient myocardial ischemia (TMI) between NSTE-ACS patients with and without moderate HDRDI. This was a secondary analysis. OSA events were identified from 12-lead ECG Holter recordings using QRSs, R-R intervals, and the myogram. Moderate OSA was defined as an HDRDI ≥15 events per/hour. TMI was defined as ≥1 millimeter of ST-segment ↑ or ↓, in ≥ 1 ECG lead, ≥ 1 minute. In 110 NSTE-ACS patients, 39% (n=43) had moderate HDRDI. Peak troponin was higher in patients with moderate HDRDI (6.8 ng/ml yes vs. 10.2 ng/ml no; p=0.037). There was a trend for fewer TMI events, but there were no differences (16% yes vs. 30% no; p=0.081). NSTE-ACS patients with moderate HDRDI have less cardiac injury than those without moderate HDRDI measured using a novel ECG derived method. These findings corroborate prior studies suggesting a possible cardioprotective effect of OSA in ACS patients via ischemic pre-condition. There was a trend for fewer TMI events in moderate HDRDI patients, but there was no statistical difference. Future research should explore the underlying physiologic mechanisms of this finding.