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Volume 14 No. 10
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Scientific Investigations

Sleep Apnea Evolution and Left Ventricular Recovery After Percutaneous Coronary Intervention for Myocardial Infarction

Li-Ling Tan, MBBS1; Jeanette Ting, MBBS1; Iswaree Balakrishnan, MB, Bch, BAO1; Aruni Seneviratna, MBBS1; Lingli Gong, MD2; Mark Y. Chan, MBBS, PhD1,2,3; E. Shyong Tai, MB, ChB, PhD2,4; A. Mark Richards, MD, PhD1,2,3,5; Bee-Choo Tai, PhD6; Lieng-Hsi Ling, MD1,2,3; Chi-Hang Lee, MD1,2,3
1Department of Cardiology, National University Heart Centre Singapore, Singapore; 2Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 3Cardiovascular Research Institute, National University Health System, Singapore; 4University Medicine Cluster, National University Health System, Singapore; 5Department of Medicine, University of Otago, Christchurch, New Zealand; 6Saw Swee Hock School of Public Health, National University of Singapore, Singapore

Study Objectives:

Sleep apnea is often newly diagnosed in patients presenting with ST-segment elevation myocardial infarction (STEMI). We assessed longitudinal changes in apnea-hypopnea index (AHI) and sleep apnea phenotype after STEMI and determined its association with changes in the left ventricular ejection fraction (LVEF).

Methods:

A total of 101 eligible patients with STEMI underwent consecutive sleep studies and echocardiographic studies within 5 days of admission and at 6-month follow-up. Sleep apnea (AHI ≥ 15 events/h) was further divided into obstructive sleep apnea (OSA) or central sleep apnea (CSA).

Results:

Both AHI (mean difference −6.4 events/h, 95% confidence interval [CI] −9.6 to 3.3, P < .001) and LVEF (mean difference 2.6%, 95% CI 1.3 to 4.0, P < .001) improved from baseline to 6 months. The improvement in AHI was associated with an increase in LVEF (β = −.47, 95% CI −.86 to −.07, P = .023) and a decrease in left ventricular end-systolic volume (LVESV) (β = .25, 95% CI .07 to .43, P = .007). Of the patients with OSA at baseline (46%), resolution of OSA was seen in 48% at 6 months. Of those with CSA at baseline (12%), conversion to OSA was seen in 83%. In contrast, among those with no sleep apnea (42%) at baseline, the diagnosis remained the same in 93% at 6 months.

Conclusions:

Concurrent changes in AHI, LVEF, and LVESV were seen after STEMI. Sleep studies performed on admission are reliable in excluding sleep apnea. However, patients with OSA or CSA on admission warrant re-evaluation due to evolution of the sleep apnea phenotype.

Citation:

Tan LL, Ting J, Balakrishnan I, Seneviratna A, Gong L, Chan MY, Tai ES, Richards AM, Tai BC, Ling LH, Lee CH. Sleep apnea evolution and left ventricular recovery after percutaneous coronary intervention for myocardial infarction. J Clin Sleep Med. 2018;14(10):1773–1781.


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