title: Complicated course of ischemic heart disease in a patient with obstructive sleep apnea.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) can activate pathological routes which can lead to insulin resistance, development of atherosclerosis and hypertension. The combination of hypertension and OSA has an additive effect on the development of atherosclerosis. As a number of studies have revealed, that the incidence of OSA in patients with myocardial infarction is likely to be high.
  
  
  RESULTS
  We present a patient with acute myocardial infarction and no classical coronary artery disease risk factors: non-smoker, normal blood pressure, normal total and low-density lipoprotein cholesterol levels, borderline high-density lipoprotein cholesterol level, with good physical activity, no diabetes mellitus, no abdominal obesity, a negative family history. The only risk factor was untreated obstructive sleep apnea. The course of disease was complicated by subsequent in-stent restenosis and progression of atherosclerotic plaques, which led to the need for acute coronary artery bypass graft surgery complicated by consecutive in-anastomosis stenosis despite maximum cardiovascular therapy. One year of continuous positive airway pressure treatment was needed to stabilize his health condition, which is now stable for up to two years.
  
  
  CONCLUSIONS
  Given the complicated course of ischemic heart disease in patients with OSA, we believe that OSA diagnosis would be advisable each time these patients with symptoms of myocardial infarction, ischemic heart disease and OSA are examined. Even more important, however, is proper treatment of the OSA when it is present.
authors.affiliation: 1st Department of Internal Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic. eliska.sovova@seznam.cz
authors.forename: Eliska
authors.initials: E
authors.lastname: Sovova
authors.forename: Milan
authors.initials: M
authors.lastname: Sova
authors.forename: Milada
authors.initials: M
authors.lastname: Hobzova
authors.forename: Milan
authors.initials: M
authors.lastname: Kaminek
authors.forename: Vitezslav
authors.initials: V
authors.lastname: Kolek
authors.forename: Milos
authors.initials: M
authors.lastname: Taborsky
authors.forename: Jiri
authors.initials: J
authors.lastname: Ostransky
mesh_terms: D003324:Coronary Artery Disease / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000175:diagnosis