title: Effects of moderate-to-severe obstructive sleep apnea on the clinical manifestations of plaque vulnerability and the progression of coronary atherosclerosis in patients with acute coronary syndrome.
abstract: OBJECTIVE
  It is unclear whether obstructive sleep apnea (OSA) increases the recurrence of acute coronary syndrome (ACS) in patients with acute myocardial infarction (MI). We hypothesized that moderate-to-severe OSA increased the number of adverse cardiovascular events in patients who underwent primary percutaneous coronary intervention (PCI).
  
  
  RESULTS
  This study included 272 patients with acute MI. Polysomnography at first admission determined that 124 patients suffered from moderate-to-severe OSA. The main study outcome measures were cardiac death, recurrence of ACS, and re-admission for heart failure. Major adverse cardiac events (MACEs) were defined as composite end points of individual clinical outcomes. Follow-up coronary angiograms were obtained in 222 patients. PCI-related measures were target vessel revascularization and newly necessitated PCI for progressive lesions. The moderate-to-severe OSA patients had increased ACS recurrence and MACEs compared with patients with mild OSA or without sleep apnea (16% vs. 7%, p = 0.014; 22% vs. 11%, p = 0.014, respectively). PCI for progressive lesions was also higher in the moderate-to-severe OSA patients (28% vs. 15%, p = 0.015). Cox regression analysis showed that moderate-to-severe OSA was an independent predictor of ACS recurrence (hazard ratio = 2.30, p = 0.040). In addition, moderate-to-severe OSA was an independent predictor of PCI for progressive lesions, with a hazard ratio of 2.38 (p = 0.015).
  
  
  CONCLUSIONS
  Moderate-to-severe OSA increased the risk of ACS and the incidence of PCI for progressive lesions. Increased plaque vulnerability might be related to these clinical manifestations.
authors.affiliation: Department of Cardiology, Nagasaki Citizens Hospital, Japan nakashima.h@nagasaki.email.ne.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakashima
authors.affiliation: Department of Cardiology, Nagasaki Citizens Hospital, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Kurobe
authors.affiliation: Department of Cardiology, Nagasaki Citizens Hospital, Japan.
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Minami
authors.affiliation: Department of Cardiology, Nagasaki Citizens Hospital, Japan.
authors.forename: Shinnosuke
authors.initials: S
authors.lastname: Furudono
authors.affiliation: Department of Cardiology, Nagasaki Citizens Hospital, Japan.
authors.forename: Yuzou
authors.initials: Y
authors.lastname: Uchida
authors.affiliation: Department of Cardiology, Nagasaki Citizens Hospital, Japan.
authors.forename: Kentarou
authors.initials: K
authors.lastname: Amenomori
authors.affiliation: Department of Cardiology, Nagasaki Citizens Hospital, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nunohiro
authors.affiliation: Department of Cardiology, Nagasaki Citizens Hospital, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takeshita
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Biomedical Science, Nagasaki University, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Maemura
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000473:pathology / Q000601:surgery; D000368:Aged; D016022:Case-Control Studies; D045422:Continuous Positive Airway Pressure; D003324:Coronary Artery Disease / Q000209:etiology* / Q000473:pathology; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000473:pathology / Q000601:surgery; D058226:Plaque, Atherosclerotic / Q000150:complications* / Q000473:pathology; D017286:Polysomnography; D012008:Recurrence; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000473:pathology / Q000628:therapy; D016896:Treatment Outcome
keywords: Acute coronary syndrome; myocardial infarction; obstructive sleep apnea; percutaneous coronary intervention; prognosis