Abstract
Coronary artery disease (CAD) patients with obstructive sleep apnoea (OSA) have increased risk for major adverse cardiovascular and cerebrovascular events (MACCEs) compared with CAD patients without OSA. We aimed to address if the risk is similar in both groups when OSA patients are treated.This study was a parallel observational arm of the RICCADSA randomised controlled trial, conducted in Sweden between 2005 and 2013. Patients with revascularised CAD and OSA (apnoea–hypopnoea index (AHI) ≥15 events·h−1) with daytime sleepiness (Epworth Sleepiness Scale score ≥10) were offered continuous positive airway pressure (CPAP) (n=155); CAD patients with no OSA (AHI <5 events·h−1) acted as controls (n=112), as a randomisation of sleepy OSA patients to no treatment would not be ethically feasible. The primary end-point was the first event of MACCEs. Median follow-up was 57 months.The incidence of MACCEs was 23.2% in OSA patients versus 16.1% in those with no OSA (adjusted hazard ratio 0.96, 95% CI 0.40–2.31; p=0.923). Age and previous revascularisation were associated with increased risk for MACCEs, whereas coronary artery bypass grafting at baseline was associated with reduced risk.We conclude that the risk for MACCEs was not increased in CAD patients with sleepy OSA on CPAP compared with patients without OSA.
Highlights
Half of clinical populations with coronary artery disease (CAD) have obstructive sleep apnoea (OSA) and these individuals have worse prognosis compared with CAD patients without OSA [1]
The results showed that the risk for major adverse cardiac and cerebrovascular events (MACCEs) in revascularised CAD patients with sleepy OSA on Continuous positive airway pressure (CPAP) was similar to that in CAD patients without OSA
Age and former revascularisation were associated with an increased risk for MACCEs, while coronary artery bypass grafting (CABG) appeared to be superior to percutaneous coronary intervention (PCI) for reducing the risk for subsequent MACCEs in this cohort
Summary
Half of clinical populations with coronary artery disease (CAD) have obstructive sleep apnoea (OSA) and these individuals have worse prognosis compared with CAD patients without OSA [1]. Despite advances in medical treatment and revascularisation techniques, many CAD patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) experience major adverse cardiac and cerebrovascular events (MACCEs) in the years following the intervention [2, 3]. In a 6-month follow-up study after PCI, MACCEs were observed in almost 24% of patients with concomitant OSA compared with 5% of those without OSA [4]. An observational, nonrandomised study suggested that patients who received CPAP treatment for OSA had reduced cardiac mortality at 5 years after PCI compared with those who declined CPAP treatment [12]. There was a lack of long-term prospective randomised controlled trials (RCTs) to address whether cardiac patients with nonsleepy OSA should be offered CPAP treatment to reduce MACCEs
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
