title: Sleep apnoea is associated with major cardiac events in peripheral arterial disease.
abstract: Obstructive sleep apnoea (OSA) is associated with atherosclerosis and cardiovascular events. Peripheral arterial disease (PAD) represents severe atherosclerosis with a high mortality after vascular surgery. The role of OSA in the prognosis of these patients is not yet established. 84 patients (aged 67 ± 9 years) scheduled for sub-inguinal surgical revascularisation were enrolled for preoperative polysomnography. The threshold for significant OSA was an apnoea/hypopnoea index ≥ 20 events·h(-1). Major adverse cardiovascular and cerebrovascular events (MACCE), including cardiac death, myocardial infarction, coronary revascularisation, angina pectoris requiring hospitalisation and stroke, were used as a combined end-point. During follow-up (median 52 months), 17 out of 39 patients with and six out of 45 patients without significant OSA suffered MACCE. In the multivariate Cox regression, the primary predictors of MACCE were significant OSA (hazard ratio (HR) 5.1 (95% CI 1.9-13.9); p=0.001) and pre-existing coronary artery disease (HR 4.4 (95% CI 1.8-10.6); p=0.001). Other significant predictors were a ≥ 4 year history of PAD (HR 3.8 (95% CI 1.3-11.5); p=0.02) and decreasing high-density lipoprotein/total cholesterol ratio (HR 0.95 per percentage (95% CI 0.90-1.00); p=0.048). OSA is associated with poor long-term outcome in patients with PAD following revascularisation. OSA might have an important role in the pathogenesis of cardiovascular morbidity and mortality in these patients.
authors.affiliation: Division of Medicine, Turku University Hospital, Turku Sleep Research Unit, University of Turku, Turku.
authors.forename: Karri T
authors.initials: KT
authors.lastname: Utriainen
authors.affiliation: Heart Centre, Turku University Hospital and University of Turku, Turku.
authors.forename: Juhani K
authors.initials: JK
authors.lastname: Airaksinen
authors.affiliation: Sleep Research Unit, University of Turku, Turku Dept of Pulmonology, Tampere University Hospital, Tampere.
authors.forename: Olli
authors.initials: O
authors.lastname: Polo
authors.affiliation: Division of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku.
authors.forename: Ruut
authors.initials: R
authors.lastname: Laitio
authors.affiliation: Heart Centre, Turku University Hospital and University of Turku, Turku.
authors.forename: Mikko J
authors.initials: MJ
authors.lastname: Pietilä
authors.affiliation: Division of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku.
authors.forename: Harry
authors.initials: H
authors.lastname: Scheinin
authors.affiliation: Dept of Biostatistics, University of Turku, Turku.
authors.forename: Tero
authors.initials: T
authors.lastname: Vahlberg
authors.affiliation: Division of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku.
authors.forename: Kari A
authors.initials: KA
authors.lastname: Leino
authors.affiliation: Division of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku.
authors.forename: Erkki S
authors.initials: ES
authors.lastname: Kentala
authors.affiliation: Division of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku.
authors.forename: Jouko R
authors.initials: JR
authors.lastname: Jalonen
authors.affiliation: Dept of Vascular Surgery, Turku University Hospital, Turku.
authors.forename: Harri
authors.initials: H
authors.lastname: Hakovirta
authors.affiliation: Dept of Radiology, Turku University Hospital, Turku, Finland.
authors.forename: Riitta
authors.initials: R
authors.lastname: Parkkola
authors.affiliation: Dept of Radiology, Turku University Hospital, Turku, Finland.
authors.forename: Sami
authors.initials: S
authors.lastname: Virtanen
authors.affiliation: Division of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku timo.laitio@elisanet.fi.
authors.forename: Timo T
authors.initials: TT
authors.lastname: Laitio
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000150:complications; D050197:Atherosclerosis / Q000150:complications* / Q000401:mortality; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality; D062645:Percutaneous Coronary Intervention; D058729:Peripheral Arterial Disease / Q000150:complications* / Q000401:mortality; D017286:Polysomnography; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012890:Sleep; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D008076:Cholesterol, HDL; D002784:Cholesterol