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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Treatment of Obstructive Sleep Apnea Is Associated With Decreased Cardiac Death After Percutaneous Coronary Intervention

Andrew Cassar, MD, MRCP^_*, Timothy I. Morgenthaler, MD, FCCP, Ryan J. Lennon, MS, Charanjit S. Rihal, MD, FACC and Amir Lerman, MD, FACC^,_*

^_* Department of Internal Medicine, Mayo College of Medicine, Rochester, Minnesota
Division of Pulmonary and Critical Care, Mayo College of Medicine, Rochester, Minnesota
Division of Biostatistics, Mayo College of Medicine, Rochester, Minnesota
Division of Cardiovascular Disease, Mayo College of Medicine, Rochester, Minnesota.

Manuscript received March 13, 2007; revised manuscript received May 29, 2007, accepted June 18, 2007.

^_* Reprint requests and correspondence: Dr. Amir Lerman, Division of Cardiovascular Disease and Department of Internal Medicine, Mayo College of Medicine, 200 First Street SW, Rochester, Minnesota 55902. (Email: lerman.amir{at}mayo.edu).

Objectives: Our purpose was to compare outcomes of patients treated for obstructive sleep apnea (OSA) versus patients with untreated OSA, all of whom had undergone percutaneous coronary intervention (PCI).

Background: Obstructive sleep apnea has been associated with increases in fatal and nonfatal cardiovascular events. It is not known whether treatment of OSA in patients who have had PCI results in a better outcome.

Methods: In a retrospective cohort study, a group of patients with OSA diagnosed with polysomnography between 1992 and 2004 (apnea-hypopnea index 15) who subsequently underwent a PCI (n = 371) were stratified according to whether they were treated for OSA (n = 175) or not (n = 196). Main outcome measures were cardiac death, general mortality, major adverse cardiac events (MACE) (severe angina, myocardial infarction, PCI, coronary artery bypass grafting, or death), and major adverse cardiac or cerebrovascular events (MACCE).

Results: Patients treated for OSA had a statistically significant decreased number of cardiac deaths on follow-up when compared with untreated OSA patients (3% [95% confidence interval (CI) 0% to 6%] vs. 10% [95% CI 5% to 14%] after 5 years, p = 0.027), as well as a trend toward decreased all-cause mortality (p = 0.058). There was no difference in the number of MACE or MACCE between the 2 groups (p = 0.91 and 0.96, respectively).

Conclusions: Treatment of OSA is associated with a reduction in the number of cardiac deaths, but not in MACE or MACCE, after PCI. Screening for and treating OSA in patients with coronary artery disease who may undergo PCI may result in decreased cardiac death.

Abbreviations and Acronyms   AHI = apnea-hypopnea index   CABG = coronary artery bypass graft   CAD = coronary artery disease   CI = confidence interval   CPAP = continuous positive airway pressure   MACCE = major adverse cardiac or cerebrovascular events   MACE = major adverse cardiac events   MI = myocardial infarct   OSA = obstructive sleep apnea   PCI = percutaneous coronary intervention

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