Obstructive sleep apnoea and coronary revascularisation outcomes.

Abstract

Obstructive sleep apnoea (OSA) is achronic sleep disorder characterised by recurrent cyclical episodes of upper airway collapse causing apnoea or hypopnoea. Despite being highly prevalent in patients with cardiovascular conditions, OSA has been aneglected component in cardiovascular practice. Fortunately, in the past few decades, increasing acknowledgement of the vulnerability of cardiac patients to OSA-related stressors and its adverse cardiovascular outcomes has made it arecognised cardiovascular risk factor in practice guidelines. Consequences of OSA include oxidative stress, endothelial dysfunction, autonomic dysfunction, and increased catecholamine release. The perturbations caused by OSA not only provide aclear mechanistic link to cardiovascular disease but also to poor outcomes after coronary revascularisation. This review article focuses on the correlation of OSA to coronary revascularisation outcomes. Our team reported that OSA is present in approximately 50% of patients undergoing coronary revascularisation. Importantly, untreated OSA was found to be an independent predictor of adverse events after both percutaneous coronary intervention and coronary artery bypass grafting. Although randomised trials did not confirm the benefits of OSA treatment in improving cardiovascular outcomes, these early trials were limited by poor treatment adherence. For now, systematic screening for OSA in patients undergoing coronary revascularisation is not indicated. Yet, with the proven benefit of OSA treatment in improving blood pressure control and quality of life, screening for and treatment of OSA is still indicated if patients have reported excessive daytime sleepiness and/or suboptimally controlled hypertension.