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Severity of obstructive sleep apnea and extension of coronary artery disease

Sleep and Breathing volume 23, pages 747–752 (2019)Cite this article

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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Funding

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.

Author information

Affiliations

  1. School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    Silveria J. Rivera-Pérez, Denis Martinez, Gustavo N. Araujo, Marco V. Wainstein & Jorge P. Ribeiro

  2. Division of Cardiology, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, RS, 90035-003, Brazil

    Denis Martinez, Gustavo N. Araujo, Sandro C. Goncalves, Rodrigo V. Wainstein, Marco V. Wainstein & Jorge P. Ribeiro

  3. College of Arts and Sciences, University of Miami, Miami, USA

    Laura K. Lazzaretti

Author notes

  1. Jorge P. Ribeiro is deceased. This paper is dedicated to his memory.

    • Jorge P. Ribeiro
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  1. Silveria J. Rivera-Pérez
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  2. Denis Martinez
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Corresponding author

Correspondence to Gustavo N. Araujo.

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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.

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

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Comment

In this relatively small study which used PSG to assess SDB in patients having coronary angiography and in which CAD severity was measured using the Gensini score showed that AHI was a powerful predictor of the presence of CAD when conventional risk factors were not. This implies AHI may indeed be an important risk factor for developing coronary artery disease. The relationship between OSA and coronary artery disease in both its chronic and acute forms is a critical one given the prevalence of OSA in patients with CAD. The authors show there is a relationship between OSA and CAD which seems not to reflect OSA severity defined using conventional agreed severity criteria. Larger studies are needed to determine whether AHI or ODI are indeed equivalent and whether PSG is really needed to stratify OSA severity. A coronary calcium score would be of interest but is obtained from CT not angiography. The study should encourage more investigation discourse on this topic

Ian Wilcox

NSW, Australia

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Rivera-Pérez, S.J., Martinez, D., Araujo, G.N. et al. Severity of obstructive sleep apnea and extension of coronary artery disease. Sleep Breath 23, 747–752 (2019). https://doi.org/10.1007/s11325-018-1769-5

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  • DOI: https://doi.org/10.1007/s11325-018-1769-5

Keywords

  • Sleep apnea
  • Atherosclerosis
  • Cardiovascular disease
  • Coronary disease
  • Gensini score