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Increased risk of stroke in patients with coronary artery disease and sleep apnea: a 10-year follow-up
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Pulmonary Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neurophysiology.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
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2008 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 118, no 9, 955-960 p.Article in journal (Refereed) Published
Abstract [en]

Background The effect of sleep apnea on mortality and cardiovascular morbidity is mainly unknown. We aimed to study whether sleep apnea is related to stroke, death, or myocardial infarction in patients with symptomatic coronary artery disease.

Methods and Results A total of 392 men and women with coronary artery disease referred for coronary angiography were examined by use of overnight sleep apnea recordings. Sleep apnea, defined as an apnea-hypopnea index ≥5, was recorded in 54% of the patients. All patients were followed up prospectively for 10 years, and no one was lost to follow-up. Stroke occurred in 47 (12%) of 392 patients during follow-up. Sleep apnea was associated with an increased risk of stroke, with an adjusted hazard ratio of 2.89 (95% confidence interval 1.37 to 6.09, P=0.005), independent of age, body mass index, left ventricular function, diabetes mellitus, gender, intervention, hypertension, atrial fibrillation, a previous stroke or transient ischemic attack, and smoking. Patients with an apnea-hypopnea index of 5 to 15 and patients with an apnea-hypopnea index ≥15 had a 2.44 (95% confidence interval 1.08 to 5.52) and 3.56 (95% confidence interval 1.56 to 8.16) times increased risk of stroke, respectively, than patients without sleep apnea, independent of confounders (P for trend=0.011). Death and myocardial infarction were not related to sleep apnea. Intervention in the form of coronary artery bypass grafting or percutaneous coronary intervention was related to a longer survival but did not affect the incidence of stroke.

Conclusions Sleep apnea is significantly associated with the risk of stroke among patients with coronary artery disease who are being evaluated for coronary intervention.

Place, publisher, year, edition, pages
New York: American Heart Association , 2008. Vol. 118, no 9, 955-960 p.
Keyword [en]
sleep apnea syndromes, coronary disease, stroke, prognosis, risk factors, myocardial infarction
National Category
Respiratory Medicine and Allergy
Research subject
Medicine
Identifiers
URN: urn:nbn:se:umu:diva-19444DOI: 10.1161/CIRCULATIONAHA.108.783290PubMedID: 18697817OAI: oai:DiVA.org:umu-19444DiVA: diva2:201787
Available from: 2009-03-05 Created: 2009-03-05 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Obstructive sleep apnea: the relationship to cardiovascular disease, diabetes mellitus, motor vehicle driving and ambient temperature
Open this publication in new window or tab >>Obstructive sleep apnea: the relationship to cardiovascular disease, diabetes mellitus, motor vehicle driving and ambient temperature
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Obstructive sleep apnea is a common disorder, especially in men. Patients with this condition often snore and suffer from excessive daytime sleepiness. It is a treatable condition related to cardiovascular disease, road traffic accidents and obesity.

Aims: To study whether snoring and witnessed sleep apnea are related to diabetes mellitus and whether sleepy subjects who snore or report sleep apneas drive more than others. To investigate whether sleep apnea is related to stroke, mortality and myocardial infarction in patients with coronary artery disease. To study the effect of ambient temperature on sleep apnea, morning alertness and sleep quality in patients with obstructive sleep apnea.

Methods and results: Questions on snoring, sleep apnea, daytime sleepiness and yearly driving distance were included in the northern Sweden component of the WHO MONICA study. Analyzed were 7905 randomly selected men and women aged 25-79 years. Snoring and witnessed sleep apnea were related to diabetes mellitus in women, (OR 1.58, p = 0.041 and OR 3.29, p = 0.012 respectively), independent of obesity, age and smoking, but not in men. Sleepy snoring men drove a mean of 22566 km per year which was more than others who drove 17751 km per year independent of age, BMI, smoking and physical activity (p = 0.02). Sleepy men reporting sleep apnea also drove more (p = 0.01). 392 men and women with coronary artery disease referred for coronary angiography were examined with overnight sleep apnea recordings and followed for 10 years. Sleep apnea was recorded in 211 (54%) of patients at baseline. Stroke occurred in 47 (12%) patients at follow up. Sleep apnea was associated with an increased risk of stroke (HR 2.89, 95% CI 1.37 - 6.09, p = 0.005) independent of age , BMI, left ventricular function, diabetes mellitus, gender, intervention, hypertension, atrial fibrillation, a previous stroke or TIA and smoking. The risk of stroke increased with the severity of sleep apnea. 40 patients with obstructive sleep apnea were investigated with overnight polysomnography in ambient temperatures of 16°C, 20°C and 24°C in random order. Total sleep time was a mean of 30 minutes longer (p = 0.009), sleep efficiency higher (p = 0.012), patients were more alert in the morning (p = 0.028), but sleep apnea was more severe when sleeping in 16°C (p = 0.001) and 20°C (p = 0.033) vs. 24°C. The AHI was 30 ± 17 in 16ºC room temperature, 28 ± 17 in 20°C and 24 ± 18 in 24°C.

Conclusions: Snoring and witnessed sleep apneas are related to diabetes mellitus in women. Sleepy men who snore or report sleep apnea drive more than others. Sleep apnea is independently associated with the risk of stroke among patients with coronary artery disease. Subjects with obstructive sleep apnea sleep longer, are more alert in the morning after a night’s sleep, but sleep apnea is more severe when sleeping in a colder environment.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2011. 61 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1452
Keyword
Obstructive sleep apnea. Snoring. Cardiovascular disease. Stroke. Diabetes mellitus. Traffic accidents. Ambient temperature.
National Category
Respiratory Medicine and Allergy
Research subject
Medicine
Identifiers
urn:nbn:se:umu:diva-48616 (URN)978-91-7459-291-7 (ISBN)
Public defence
2011-11-18, Sal B, Målpunkt T9, Norrlands universitetssjukhus 901 85, Umeå, 13:00 (Swedish)
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Available from: 2011-10-28 Created: 2011-10-26 Last updated: 2011-10-28Bibliographically approved

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