title: Clinical implications of sleep disordered breathing in acute myocardial infarction.
abstract: BACKGROUND
  Sleep disordered breathing (SDB), characterized by nightly intermittent hypoxia, is associated with multiple pathophysiologic alterations that may adversely affect patients with acute myocardial infarction (AMI). This prospective study investigated whether the metabolic perturbations associated with SDB are present when these patients develop AMI and if they affect clinical outcomes.
  
  
  METHODS
  We prospectively enrolled 180 AMI patients. SDB was defined as oxygen desaturation index (ODI) >5 events/hour based on a Watch Pat-100 sleep study. Blood samples were obtained for high-sensitivity C-reactive protein (hs-CRP) and markers of oxidative stress (lipid peroxides [PD] and serum paraoxonase-1 [PON-1] (arylesterase activity). Echocardiography was performed to evaluate cardiac dimensions and pulmonary artery systolic pressure.
  
  
  RESULTS
  SDB was present in 116 (64%) patients. Hs-CRP levels, PD and PON-1 were similar in patients with and without SDB. Echocardiography revealed higher left atrial dimension (4.1 ± 0.5 vs 3.8 ± 0.5 cm; P = 0.003) and a significant positive correlation between ODI and pulmonary artery systolic pressure (r = 0.41, P<0.0001). After a median follow up of 68 months, no significant differences were observed between the study groups with regard to clinical outcomes, including death, heart failure, myocardial infarction and unstable angina.
  
  
  CONCLUSIONS
  There is a high prevalence of previously undiagnosed SDB among patients with AMI. SDB in the setting of AMI is associated with higher pulmonary artery systolic pressure. SDB was not associated with adverse clinical outcomes.
authors: Department of Cardiology, Rambam Medical Center, Haifa, Israel.
authors: Doron
authors: D
authors: Aronson
authors: Department of Cardiology, Rambam Medical Center, Haifa, Israel.
authors: Morad
authors: M
authors: Nakhleh
authors: Department of Cardiology, Rambam Medical Center, Haifa, Israel.
authors: Tawfiq
authors: T
authors: Zeidan-Shwiri
authors: Department of Cardiology, Rambam Medical Center, Haifa, Israel.
authors: Michael
authors: M
authors: Mutlak
authors: Lloyd Rigler Sleep Apnea Research Laboratory, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors: Peretz
authors: P
authors: Lavie
authors: Lloyd Rigler Sleep Apnea Research Laboratory, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors: Lena
authors: L
authors: Lavie
mesh_terms: D000328:Adult; D000368:Aged; D043303:Aryldialkylphosphatase / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension; D000860:Hypoxia; D007249:Inflammation; D015227:Lipid Peroxidation; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000503:physiopathology*; D018384:Oxidative Stress; D010100:Oxygen / Q000097:blood; D015995:Prevalence; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000473:pathology; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000503:physiopathology*; D016896:Treatment Outcome
chemical_list: D002097:C-Reactive Protein; D043303:Aryldialkylphosphatase; D010100:Oxygen