OBSTRUCTIVE SLEEP OBSTRUCTIVE SLEEP APNEA IN PATIENTS WITH APNEA IN PATIENTS WITH

CORONARY ATERY CORONARY ATERY DISEASEDISEASE

OBSTRUCTIVE SLEEP OBSTRUCTIVE SLEEP APNEA IN PATIENTS WITH APNEA IN PATIENTS WITH

CORONARY ATERY CORONARY ATERY DISEASEDISEASE

ByByAhmad YounisAhmad Younis

Professor of Thoracic Medicine DepartmentProfessor of Thoracic Medicine DepartmentMansoura Faculty of MedicineMansoura Faculty of Medicine

Ahmad YounisAhmad YounisProfessor of Thoracic Medicine DepartmentProfessor of Thoracic Medicine Department

Mansoura Faculty of MedicineMansoura Faculty of Medicine

OSA is an emerging health challenge partially because of OSA is an emerging health challenge partially because of

its strong association with many cardiovascular disorders its strong association with many cardiovascular disorders

but more importantly due to its individual recognition as but more importantly due to its individual recognition as

an established cardiac risk factoran established cardiac risk factor .

OSA is a relatively under-diagnosed condition and

hence, the majority of OSA patients would have

developed a cardiovascular condition before a formal

diagnosis of OSA is made.

Aim of the workAim of the work

The aim of this work was to determine the frequency of The aim of this work was to determine the frequency of

OSA in patients with CAD and illustrate the correlation OSA in patients with CAD and illustrate the correlation

of severity of OSA ( AHI and nocturnal O2 desaturation of severity of OSA ( AHI and nocturnal O2 desaturation

indices ) to severity of CAD (as evidenced by coronary indices ) to severity of CAD (as evidenced by coronary

angiography)angiography)..

Subjects and methods Thirty patients with CAD as evidenced by stenosis of

coronary artery angiography were subjected to-: 1 -Thorough history taking and clinical examination

2 -ECG and echocardiogram 3 -Laboratory investigation include arterial blood

gases ,blood sugar , lipogram ,liver and kidney function tests

4 -Full night Polysomonography (PSG) for objective diagnosis of OSA

Quantitative assessment of the degree of stenosis of coronaries were

done by Gensini score .Reduction of 25% 50% 75% 90% 99% and

complete occlusion were given score 1,2,4,8,16 and32. Each principal

vascular segment was assigned a multiplier in accordance of the

myocardial area supplied by that segment . The left main coronary

multiplied by 5 , the proximal segment of the left anterior descending

coronary artery multiplied by 2.5 ,the proximal segment of the

circumflex artery multiplied by 2.5 ,the midsegment of the LAD

multiplied by 1.5 , the right coronary artery ,the distal segment of

LAD , the posterolateral artery and the obtuse marginal are multiplied

by 1 and others multiplied by 0.5 .

ResultsResults

Table (1): OSA in studied cases with CAD

N%

CAD with OSA (AHI>5/hour)1240

CAD without OSA (AHI <5 /hour)1860

Total30100

OSA obstructive sleep apnea AHI apnea hypopnea indexCAD coronary atherosclerotic disease

Table (2): Demographic data of CAD with OSA VS CAD without OSA

CAD with OSA

N = 12

CAD without OSA

N = 18 Statistic

1- Mean Age (years)60.75 ± 2.89661 ± 2.659t = 0.244 p > 0.05

2- Mean Neck circumference (cm)

43 ± 1.044435.333 ± 1.138t = 18.66 p < 0.001

3-Mean BMI (Kg/m2)32.5 ± 1.88328.667 ± 2.2t = 5.425 p < 0.001

4-Male ratio (N/ %)9 (75%)15 (83%)2 = 0.313 p = 0.455

BMI body mass index

Table (3): Cardiovascular risk factors in CAD with OSA VS CAD without OSA

Cardiovascular risk factors

CAD with OSA

N (%)

CAD without OSA

N (%) Statistic

1- HTN6 (50%)6 (33.3%)2 = 0.833 p =0.296

2- Dyslipedemia3 (25%)6 (33.3%)2 = 0.238 p =0.472

3- Smoking6 (50%)12 (66.7%)2 = 0.833 p =0.296

4- DM3 (25%)3 (16.7%)2 = 0.921 p =0.251

5- Male ratio9 (75%)15 (83%)2 = 0.313 p = 0.455

HTN hypertension, DM diabetes melitus

Table (4): Polysomonographic parameters in CAD with OSA VS CAD without OSA

CAD with OSA

Mean ± SD

CAD without OSA

Mean ± SD Statistic

1-AHI36.75 ± 2.4913.5 ± 0.786t = 53.2, p <0.001

2-Desaturation index20 ± 1.210 ± 3.2t =10.113, p <0.001

3-Average duration Sao2<90% (seconds)

25.25 ± 3.57114 ± 4.116t =7.719, p <0.001

4-%total sleep time Sao2<90%

3.538 ± 0.4861.2 ± 0.617t = 11.014, p <0.001

5-Minimum Sao2%81 ± 1.044487.8333 ± 0.707t = 21.429, p <0.001

6-Arousal index39.5 ± 1.73222.167 ± 1.917t = 25.184, p <0.001

Table (5): Quantitation of stenosis of coronary arteries in patients with CAD with

OSA VS CAD without OSA

CAD with OSA

Mean ± SD

CAD without OSA

Mean ± SD Statistic

1-Number of coronary vessel stenosis

2.25 ± 0.4521.33 ± 0.485t = 5.206, p <0.001

2-Gensini score31.5 ± 1.73217.5 ± 2.572t =16.479, p <0.001

Table (6): Correlation of Polysomonographic parameters with the

severity of stenosis of coronary angiogram

Severity of stenosis of coronary angiogram

Correlation Coefficient (r) P value

1-AHI

2-Desaturation index

3-Average duration Sao2<90%

4-% total sleep time Sao2<90%

5-Minimum Sao2%

6-Arousal index

0.563

0.452

0.557

0.490

– 0.542

0.353

< 0.001

0.001

< 0.001

< 0.001

< 0.001

0.011

conclusion

From this study we can conclude that the frequency of OSA in CAD is high (40%)

OSA is a significant risk factor for CAD as evidenced by significant positive correlation between AHI and nocturnal O2 desaturation indices with the degree of coronary artery stenosis ( Gensini score ).

Great attention should be paid to the screening of OSA in patients with CAD in order to improve CAD and its prognosis.

The timely diagnosis and treatment of OSA should be taken into account in secondary prevention of CAD

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