Severity of obstructive sleep apnea and extension of coronary artery disease

  • Silveria J. Rivera-Pérez
  • Denis Martinez
  • Gustavo N. AraujoEmail author
  • Sandro C. Goncalves
  • Laura K. Lazzaretti
  • Rodrigo V. Wainstein
  • Marco V. Wainstein
  • Jorge P. Ribeiro
Sleep Breathing Physiology and Disorders • Original Article



Obstructive sleep apnea (OSA) is highly prevalent among patients with coronary artery disease (CAD). The relationship between the severity of OSA and the severity of CAD has not been entirely established. The objective was to explore the type of correlation existent between the apnea-hypopnea index and the Gensini score, which provides granularity in terms of CAD extension and severity, in search of a dose-response relationship.


A cross-sectional study was conducted among patients that underwent cardiac catheterization due to the suspicion of CAD. Coronary lesions were classified according to one’s Gensini score. The severity of OSA was determined by the apnea-hypopnea index (AHI), obtainable through a respiratory polysomnography.


Eighty patients were eligible for the study. The mean age was 55 years, and 37% had AHI ≥ 15. Forty-four subjects (55%) had a Gensini score of 0, and five had a score < 2, indicating a 25% obstruction in a non-proximal artery; these individuals were considered non-CAD controls; and clinical characteristics were similar between them and CAD cases. Attempts to correlate the AHI with the Gensini score either converting both variables to square root (r = 0.08) or using Spearman’s rho (rho = 0.13) obtained small, non-significant coefficients. AHI ≥ 15 was a predictor of a Gensini score ≥ 2 with a large effect size (OR 4.46) when adjusted for age ≥ 55 years, BMI ≥ 25 kg/m2, uric acid, and hypertension.


In patients undergoing coronary angiography due to suspected CAD, moderate-severe OSA was associated with the presence of CAD but no significant correlation was found between the lesion severity and the AHI. Our results suggest that OSA influences CAD pathogenesis but a dose-response relationship is unlikely.


Sleep apnea Atherosclerosis Cardiovascular disease Coronary disease Gensini score 



This study was funded by the National Council of Technological and Scientific Development (CNPq) and Fundo de Incentivo a Pesquisa (FIPE) do Hospital de Clinicas de Porto Alegre, RS, Brazil, grant number 060653.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Silveria J. Rivera-Pérez
    • 1
  • Denis Martinez
    • 1
    • 2
  • Gustavo N. Araujo
    • 1
    • 2
    Email author return OK on get
  • Sandro C. Goncalves
    • 2
  • Laura K. Lazzaretti
    • 3
  • Rodrigo V. Wainstein
    • 2
  • Marco V. Wainstein
    • 1
    • 2
  • Jorge P. Ribeiro
    • 1
    • 2
  1. 1.School of MedicineUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
  2. 2.Division of CardiologyHospital de Clínicas de Porto AlegrePorto AlegreBrazil
  3. 3.College of Arts and SciencesUniversity of MiamiMiamiUSA

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