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Effects of obstructive sleep apnea hypopnea syndrome on postoperative complications in patients who undergo off-pump coronary artery bypass grafting

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

To investigate the prevalence of obstructive sleep apnea hypopnea syndrome (OSAHS) in patients undergoing off-pump coronary artery bypass grafting (OPCABG) and analyze the effects of OSAHS on the incidence of post-OPCABG complications, length of stay in intensive care unit (ICU) and hospitalization, and hospital expense.

Materials and methods

This prospective study included patients undergoing OPCABG at Beijing An Zhen hospital from January 2018 to December 2018. OSAHS was diagnosed by using a portable sleep monitor before surgery.

Results

Among 74 patients, the prevalence of OSAHS and moderate to severe OSAHS (apnea hypopnea index (AHI) ≥ 15) was 70% and 53%, respectively. Compared with the no to mild OSAHS group (AHI < 15), the moderate to severe OSAHS group presented a lower ejection fraction (P = 0.013). Between these two groups, the incidence of post-OPCABG complications; the duration of intubation, ICU stay, and hospitalization; and the hospital expense did not differ. Notably, the ejection fraction was significantly negatively correlated with the duration of ICU stay and hospital expense.

Conclusions

Patients undergoing OPCABG with severe OSAHS are likely to exhibit a low ejection fraction and poor heart function, which may require a longer ICU stay and incur higher hospital expenses.

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Abbreviations

AF:

Atrial fibrillation

AHI:

Apnea hypopnea index

BMI:

Body mass index

CPAP:

Continuous positive airway pressure

EF:

Ejection fraction

ICU:

Intensive care unit

OPCABG:

Off-pump coronary artery bypass grafting

OSAHS:

Obstructive sleep apnea–hypopnea syndrome

PG:

Polygraphy

PSG:

Polysomnography

SpO2 :

Blood oxygen saturation

VA:

Ventricular arrhythmia

References

  1. McEvoy RD, Antic NA, Heeley E, Luo Y, Ou Q, Zhang X et al (2016) SAVE Investigators and Coordinators. CPAP for prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med 375:919–31

    Article  PubMed  Google Scholar 

  2. Sforza E, Millasseau S, Hupin D, Barthélémy JC, Roche F (2019) Arterial stiffness alteration and obstructive sleep apnea in an elderly cohort free of cardiovascular event history: the PROOF cohort study. Sleep Breath 23(1):201–208

    Article  PubMed  Google Scholar 

  3. Yu Y, Gao MX, Wang C, Gu CX (2012) Bipolar radiofrequency ablation for left ventricular aneurysm related ventricular arrhythmia. J Thorac Cardiovasc Surg 144:101–102

    Article  Google Scholar 

  4. Amra B, Niknam N, Sadeghi MM, Rabbani M, Fietze I, Penzel T (2014) Obstructive sleep apnea and postoperative complications in patients undergoing coronary artery bypass graft surgery: a need for preventive strategies. Int J Prev Med 5:1446–1451

    PubMed  PubMed Central  Google Scholar 

  5. Qaddoura A, Kabali C, Drew D, van Oosten EM, Michael KA, Redfearn DP et al (2014) Obstructive sleep apnea as a predictor of atrial fibrillation after coronary artery bypass grafting: a systematic review and meta-analysis. Can J Cardiol 30:1516–1522

    Article  PubMed  Google Scholar 

  6. Vecchiato M, Neunhaeuserer D, Quinto G, Bettini S, Gasperetti A, Battista F et al (2021) Cardiopulmonary exercise testing in patients with moderate-severe obesity: a clinical evaluation tool for OSA? Sleep Breath. https://doi.org/10.1007/s11325-021-02475-0

    Article  PubMed  PubMed Central  Google Scholar 

  7. Gao M, Fan K, Yu W, Liu H, Wei Y, Yu Y (2007) The effects of high-sensitivity C-reactive protein on the clinical outcomes in obstructive sleep apnea patients undergoing off-pump coronary artery bypass grafting. BMC Cardiovasc Disord 21:366

    Article  Google Scholar 

  8. Uchôa CH, Danzi-Soares Nde J, Nunes FS, de Souza AA, Nerbass FB, Pedrosa RP et al (2015) Impact of OSA on cardiovascular events after coronary artery bypass surgery. Chest 147:1352–1360

    Article  PubMed  Google Scholar 

  9. Ward NR, Roldao V, Cowie MR, Rosen SD, McDonagh TA, Simonds AK et al (2013) The effect of respiratory scoring on the diagnosis and classification of sleep disordered breathing in chronic heart failure. Sleep 36:1341–1348

    Article  PubMed  PubMed Central  Google Scholar 

  10. Danzi-Soares NJ, Genta PR, Nerbass FB, Pedrosa RP, Soares FS, César LA et al (2012) Obstructive sleep apnea is common among patients referred for coronary artery bypass grafting and can be diagnosed by portable monitoring. Coron Artery Dis 23:31–38

    Article  PubMed  Google Scholar 

  11. van Oosten EM, Hamilton A, Petsikas D, Payne D, Redfearn DP, Zhang S et al (2014) Effect of preoperative obstructive sleep apnea on the frequency of atrial fibrillation after coronary artery bypass grafting. Am J Cardiol 113:919–923

    Article  PubMed  Google Scholar 

  12. Lee W, Nagubadi S, Kryger MH, Mokhlesi B (2008) Epidemiology of obstructive sleep apnea: a population-based perspective. Expert Rev Respir Med 2:349–364

    Article  PubMed  PubMed Central  Google Scholar 

  13. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235

    Article  CAS  PubMed  Google Scholar 

  14. Cauley JA, Gutai JP, Glynn NW, Paternostro-Bayles M, Cottington E, Kuller LH (1994) Serum estrone concentrations and coronary artery disease in postmenopausal women. Arterioscler Thromb 14:14–18

    Article  CAS  PubMed  Google Scholar 

  15. Simon JA, Hunninghake DB, Agarwal SK, Lin F, Cauley JA, Ireland CC et al (2001) Effect of estrogen plus progestin on risk for biliary tract surgery in postmenopausal women with coronary artery disease. The heart and estrogen/progestin replacement study. Ann Intern Med 135:493–501

    Article  CAS  PubMed  Google Scholar 

  16. Mikami M, Tatsumi K, Kimura H, Honda Y, Kuriyama T (1989) Respiration effect of synthetic progestin in small doses in normal men. Chest 96:1073–1075

    Article  CAS  PubMed  Google Scholar 

  17. Whittle AT, Marshall I, Mortimore IL, Wraith PK, Sellar RJ, Douglas NJ (1999) Neck soft tissue and fat distribution: comparison between normal men and women by magnetic resonance imaging. Thorax 54:323–328

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Ali SF, Smith EE, Reeves MJ, Zhao X, Xian Y, Hernandez AF et al (2015) Smoking paradox in patients hospitalized with coronary artery disease or acute ischemic stroke: findings from Get with the Guidelines. Circ Cardiovasc Qual Outcomes 8:S73–S80

    Article  PubMed  Google Scholar 

  19. Malerba M, Montuschi P (2012) Non-invasive biomarkers of lung inflammation in smoking subjects. Curr Med Chem 19:187–196

    Article  CAS  PubMed  Google Scholar 

  20. Taillé C, Rouvel-Tallec A, Stoica M, Danel C, Dehoux M, Marin-Esteban V et al (2016) Obstructive sleep apnoea modulates airway inflammation and remodelling in severe asthma. PLoS One 11:e0150042

    Article  PubMed  PubMed Central  Google Scholar 

  21. Wang J, Yu W, Gao M, Zhang F, Gu C, Yu Y et al (2015) Impact of obstructive sleep apnea syndrome per se on endothelial function, arterial stiffening, and serum inflammatory markers: an update meta-analysis and meta-regression of 18 studies. JAHA 4:e002454

  22. Hall AB, Ziadi MC, Leech JA, Chen SY, Burwash IG, Renaud J et al (2014) Effects of short-term continuous positive airway pressure on myocardial sympathetic nerve function and energetics in patients with heart failure and obstructive sleep apnea: a randomized study. Circulation 130:892–901

    Article  PubMed  Google Scholar 

  23. Bitter T, Fox H, Dimitriadis Z, Niedermeyer J, Prib N, Prinz C et al (2014) Circadian variation of defibrillator shocks in patients with chronic heart failure: the impact of Cheyne-Stokes respiration and obstructive sleep apnea. Int J Cardiol 176:1033–1035

    Article  PubMed  Google Scholar 

  24. Li S, Feng J, Wei S, Qian X, Cao J, Chen B (2016) Delayed neutrophil apoptosis mediates intermittent hypoxia-induced progressive heart failure in pressure-overloaded rats. Sleep Breath 20:95–102

    Article  PubMed  Google Scholar 

  25. Gami AS, Hodge DO, Herges RM, Olson EJ, Nykodym J, Kara T et al (2007) Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol 49:565–571

    Article  PubMed  Google Scholar 

  26. Miller JD, Aronis KN, Chrispin J, Patil KD, Marine JE, Martin SS et al (2015) Obesity, exercise, obstructive sleep apnea, and modifiable atherosclerotic cardiovascular disease risk factors in atrial fibrillation. J Am Coll Cardiol 66:2899–2906

    Article  PubMed  Google Scholar 

  27. Wong JK, Maxwell BG, Kushida CA, Sainani KL, Lobato RL, Woo YJ et al (2015) Obstructive sleep apnea is an independent predictor of postoperative atrial fibrillation in cardiac surgery. J Cardiothorac Vasc Anesth 29:1140–1147

    Article  PubMed  Google Scholar 

  28. Mooe T, Gullsby S, Rabben T, Eriksson P (1996) Sleep-disordered breathing: a novel predictor of atrial fibrillation after coronary artery bypass surgery. Coron Artery Dis 7:475–478

    Article  CAS  PubMed  Google Scholar 

  29. Abuelo JG (2015) Low dialysate potassium concentration: an overrated risk factor for cardiac arrhythmia? Semin Dial 28:266–275

    Article  PubMed  Google Scholar 

  30. Huang B, Zhou X, Wang Z, Wang S, Yu L, Jiang H (2015) Extracardiac autonomic modulations: potential therapeutic options for myocardial ischemia-induced ventricular arrhythmia. Int J Cardiol 188:45–46

    Article  PubMed  Google Scholar 

  31. Raghuram A, Clay R, Kumbam A, Tereshchenko LG, Khan A (2014) A systematic review of the association between obstructive sleep apnea and ventricular arrhythmias. J Clin Sleep Med 10:1155–1160

    Article  PubMed  PubMed Central  Google Scholar 

  32. Wang J, Yu W, Gao M, Zhang F, Li Q, Gu C et al (2015) Continuous positive airway pressure treatment reduce cardiovascular death and non-fatal cardiovascular events in patients with obstructive sleep apnea: a meta-analysis of 11 studies. Int J Cardiol 191:218–231

    Article  Google Scholar 

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Acknowledgements

The authors of this study would like to thank all the study participants.

Funding

This study was supported by the International Science & Technology Cooperation Program of China (No. 2015DFA30160), Beijing Municipal Science & Technology Commission (No. Z141100006014057), and Beijing Municipal Administration of Hospitals Ascent Plan under Grant (No. DFL20150602). These three funds had provided portable sleep monitors for the research. The sponsor had no role in the design or conduct of this research.

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Authors and Affiliations

  1. Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing, 100029, China

    Mingxin Gao, Pengcheng Wang, Tian Tang, Wenyuan Yu & Yang Yu

  2. Department of Otolaryngology, Beijing An Zhen Hospital, Capital Medical University, Beijing, 100029, China

    Yongxiang Wei

Authors
  1. Mingxin Gao
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  2. Pengcheng Wang
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  3. Tian Tang
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  4. Wenyuan Yu
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  5. Yang Yu
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Corresponding authors

Correspondence to Yang Yu or Yongxiang Wei.

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Ethics 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. This study was approved by the Institutional Review Board of Beijing An Zhen Hospital of Capital Medical University (Approval No: 2013025).

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

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The authors declare no competing interests.

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Gao, M., Wang, P., Tang, T. et al. Effects of obstructive sleep apnea hypopnea syndrome on postoperative complications in patients who undergo off-pump coronary artery bypass grafting. Sleep Breath 26, 1897–1905 (2022). https://doi.org/10.1007/s11325-022-02649-4

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  • DOI: https://doi.org/10.1007/s11325-022-02649-4

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