title: Increased risk of stroke in patients with coronary artery disease and sleep apnea: a 10-year follow-up.
abstract: BACKGROUND
  The effect of sleep apnea on mortality and cardiovascular morbidity is mainly unknown. We aimed to study whether sleep apnea is related to stroke, death, or myocardial infarction in patients with symptomatic coronary artery disease.
  
  
  RESULTS
  A total of 392 men and women with coronary artery disease referred for coronary angiography were examined by use of overnight sleep apnea recordings. Sleep apnea, defined as an apnea-hypopnea index >or=5, was recorded in 54% of the patients. All patients were followed up prospectively for 10 years, and no one was lost to follow-up. Stroke occurred in 47 (12%) of 392 patients during follow-up. Sleep apnea was associated with an increased risk of stroke, with an adjusted hazard ratio of 2.89 (95% confidence interval 1.37 to 6.09, P=0.005), independent of age, body mass index, left ventricular function, diabetes mellitus, gender, intervention, hypertension, atrial fibrillation, a previous stroke or transient ischemic attack, and smoking. Patients with an apnea-hypopnea index of 5 to 15 and patients with an apnea-hypopnea index >or=15 had a 2.44 (95% confidence interval 1.08 to 5.52) and 3.56 (95% confidence interval 1.56 to 8.16) times increased risk of stroke, respectively, than patients without sleep apnea, independent of confounders (P for trend=0.011). Death and myocardial infarction were not related to sleep apnea. Intervention in the form of coronary artery bypass grafting or percutaneous coronary intervention was related to a longer survival but did not affect the incidence of stroke.
  
  
  CONCLUSIONS
  Sleep apnea is significantly associated with the risk of stroke among patients with coronary artery disease who are being evaluated for coronary intervention.
authors.affiliation: Department of Respiratory Medicine, University Hospital, Umeå, Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Valham
authors.forename: Thomas
authors.initials: T
authors.lastname: Mooe
authors.forename: Terje
authors.initials: T
authors.lastname: Rabben
authors.forename: Hans
authors.initials: H
authors.lastname: Stenlund
authors.forename: Urban
authors.initials: U
authors.lastname: Wiklund
authors.forename: Karl A
authors.initials: KA
authors.lastname: Franklin
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000401:mortality*; D003324:Coronary Artery Disease / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D020300:Intracranial Hemorrhages / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009203:Myocardial Infarction / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000401:mortality*; D020521:Stroke / Q000401:mortality*; D016019:Survival Analysis