Obstructive sleep apnea in patients admitted for acute myocardial infarction. Prevalence, predictors, and effect on microvascular perfusion.
BACKGROUND
We investigated the prevalence and predictors of obstructive sleep apnea (OSA) in patients admitted to the hospital for acute myocardial infarction and whether OSA has any association with microvascular perfusion after primary percutaneous coronary intervention (PCI).


METHODS
Recruited patients were scheduled to undergo an overnight sleep study between 2 and 5 days after primary PCI. An apnea-hypopnea index (AHI) of > or = 15 was considered diagnostic of OSA. Impaired microvascular perfusion after primary PCI was defined as an ST-segment resolution of < or = 70%, myocardial blush grade 0 or 1, or a corrected Thrombolysis in Myocardial Infarction (TIMI) [antegrade flow scale] frame count > 28.


RESULTS
Sleep study was performed in 120 patients and completed in 105 patients (study cohort, mean age 53 +/- 10 years, male 98%) with uncomplicated myocardial infarction. An AHI was > or = 15 in 69 patients (OSA-positive), giving a prevalence of 65.7%. Diabetes mellitus was found to be a significant risk factor for OSA (odds ratio, 2.86; 95% confidence interval, 1.06 to 8.24; p = 0.033). There were no differences between OSA-positive and OSA-negative groups with regard to the percentage of patients with < or = 70% ST-segment resolution (73% vs 64%, respectively; p = 0.411), myocardial blush grade 0 or 1 (39.1% vs 38.9%, respectively; p = 1.000), or corrected TIMI frame count > 28 (21.7% vs 25.0%, respectively; p = 0.807).


CONCLUSIONS
We found a high prevalence of previously undiagnosed OSA in patients admitted with acute myocardial infarction. Diabetes mellitus was independently associated with OSA. No evidence indicated that OSA is associated with impaired microvascular perfusion after primary PCI.
Lee
Chi-Hang
CH
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; The Heart Institute, National University Hospital, Singapore. Electronic address: mdclchr@nus.edu.sg.
Khoo
See-Meng
SM
Department of Medicine, National University Hospital, Singapore.
Tai
Bee-Choo
BC
Department of Community, Occupational and Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Chong
Eric Y
EY
The Heart Institute, National University Hospital, Singapore.
Lau
Cindy
C
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Than
Yemon
Y
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Shi
Dong-Xia
DX
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Lee
Li-Ching
LC
The Heart Institute, National University Hospital, Singapore.
Kailasam
Anand
A
The Heart Institute, National University Hospital, Singapore.
Low
Adrian F
AF
The Heart Institute, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Teo
Swee-Guan
SG
The Heart Institute, National University Hospital, Singapore.
Tan
Huay-Cheem
HC
The Heart Institute, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
D000328:Adult; D017677:Age Distribution; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D015331:Cohort Studies; D015897:Comorbidity; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D017286:Polysomnography; D011237:Predictive Value of Tests; D015995:Prevalence; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology*; D018709:Statistics, Nonparametric; D015996:Survival Rate