Influence of sleep-disordered breathing assessed by pulse oximetry on long-term clinical outcomes in patients who underwent percutaneous coronary intervention
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Sleep-disordered breathing (SDB) has been recognized as an important risk factor for coronary artery disease (CAD). However, SDB was not fully examined, because sleep studies are limited. Nocturnal pulse oximetry has been suggested to be a useful tool for evaluating SDB. Therefore, the aim of this study was to investigate the influence of SDB assessed by nocturnal pulse oximetry on clinical outcomes in patients who underwent percutaneous coronary intervention (PCI).
We conducted a prospective, multicenter, observational cohort study, wherein SDB was assessed by finger pulse oximetry in patients who underwent PCI from January 2014 to December 2016. SDB was defined as 4% oxygen desaturation index of 5 and higher. The primary endpoint was major adverse cardiac or cerebrovascular event (MACCE), defined as a composite of all-cause mortality, acute coronary syndrome, and/or stroke.
Of 539 patients, 296 (54.9%) had SDB. MACCE occurred in 32 patients (5.8%) during a median follow-up of 1.9 years. The cumulative incidence of MACCE was significantly higher in patients with SDB (P = 0.0134). In the stepwise multivariable Cox proportional model, the presence of SDB was a significant predictor of MACCE (hazard ratio 2.26; 95% confidence interval 1.05–5.4, P = 0.036).
SDB determined by nocturnal pulse oximetry was associated with worse clinical outcomes in patients who underwent PCI. Screening for SDB with nocturnal pulse oximetry was considered to be important for risk stratification in patients with CAD.
KeywordsSleep disordered breathing Pulse oximetry Coronary artery disease Percutaneous coronary intervention Mortality
SY and RN had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. TK is the guarantor of the content of the manuscript and contributed substantially to the study concept and design, data analysis and interpretation, drafting of the manuscript, and review of the manuscript for important intellectual content. HM, JS, MS, AM, TK, SS, MH, ES, KM, and HD contributed to the drafting of the manuscript and review of the manuscript for important intellectual content.
This study is partly supported by a Grant-in-Aid for Scientific Research (C) [Grant Number 26507010] and a grant to the Respiratory Failure Research Group from the Ministry of Health, Labor and Welfare, Japan. These funding sources do not have any other roles in this study.
Compliance with ethical standards
Conflict of interest
Drs. Takatoshi Kasai, Shoko Suda, and Hiroki Matsumoto are affiliated with a department endowed by Philips Respironics, ResMed, Teijin Home Healthcare, and Fukuda Denshi. K. Miyauchi received manuscript fees, research funds, and scholarship funds from Amgen, Astellas Pharma Inc, MSD, Bayer Health Care, Sanofi, Takeda Pharmaceutical Co. Ltd., Dai-ichi Sankyo Company, Boehringer-ingelheim, Bristol-Myers Squibb. H. Daida received manuscript fees, research funds, and scholarship funds from Kirin Co., Ltd., Kaken Pharmaceutical Co., Ltd., Abbott Japan Co., Ltd., Astellas Pharma Inc, Astrazeneca K.K., Bayer Yakuhin, Ltd, Boston Scientific Japan K.K., Bristol-Myers Squibb, Daiichi Sankyo Company, MSD K.K., Pfizer Inc., Philips Respironics, Sanofi K.K., and Takeda Pharmaceutical Co., Ltd. The other authors report no conflicts of interest.
Role of the sponsors
The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript.
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