P1123Impact of central and obstructive sleep apnea on long term clinical outcomes in patients with acute myocardial infarction

Abstract

Background: There are many associations between sleep disordered breathing (SDB) and cardiovascular diseases. Obstructive sleep apnoea (OSA) has been identified as an important risk factor for a variety of cardiovascular diseases such as hypertension, coronary artery disease and atrial fibrillation. Central sleep apnoea (CSA) has mainly been associated with chronic congestive heart failure and carries a significantly adverse prognosis. Purpose: To examine the hypothesis that SDB may increase the adverse cardiac events in patients with acute myocardial infarction (AMI) after primary percutaneous coronary intervention (PCI). Methods: This study included 339 patients with AMI who underwent primary PCI within 24 h of onset. All patients underwent polysomnography before discharge; SDB was defined as apnoea-hypopnea index ≥15 events/h. Patients were divided into three groups: OSA group, CSA group and control group. The main outcome measures were cardiac death, recurrence of acute coronary syndrome and readmission for heart failure. Major adverse cardiac events (MACE) were defined as composite end points of individual clinical measures. Results: The median follow-up duration was 1830 days. CSA and OSA were noted in 29 patients (7.1%) and 132 patients (38.9%), respectively. The CSA group had increased cardiac death and MACE compared with the OSA and control groups (16.7% vs. 2.2% vs. 4.6%, p=0.004; 33.4% vs. 24.8% vs. 22.0%, p=0.047, respectively). Kaplan-Meier curves demonstrated significantly different cardiac death among the three groups (log-rank p=0.004). A multivariate Cox proportional hazard model adjusted for male sex, age, hypertension, diabetes mellitus, current smoking, dyslipidemia and peak creatine kinase showed that CSA was an independent predictor of cardiac death and re-admission for heart failure (hazard ratio = 7.49, 95% confidence interval: 1.35-45.9, p=0.022; hazard ratio = 4.36, 95% confidence interval: 1.07-16.9, p=0.041, respectively). Conclusion: Among patients with AMI, CSA increases the risk of heart failure and cardiac death.