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Original Research: SLEEP DISORDERS |

Patients With Obstructive Sleep Apnea Exhibit Impaired Endothelial Function After Myocardial InfarctionEndothelial Function After Myocardial Infarction

Fatima H. Sert Kuniyoshi, PhD; Prachi Singh, PhD; Apoor S. Gami, MD; Arturo Garcia-Touchard, MD; Christelle van der Walt, RPSGT; Snigdha Pusalavidyasagar, MD; R. Scott Wright, MD; Elisardo Corral Vasquez, PhD; Francisco Lopez-Jimenez, MD; Virend K. Somers, MD, PhD, FCCP
Author and Funding Information

From the Division of Cardiovascular Diseases, Department of Internal Medicine (Drs Sert Kuniyoshi, Singh, Gami, Garcia-Touchard, Pusalavidyasagar, Wright, Lopez-Jimenez, and Somers; and Ms van der Walt), Mayo Clinic and Foundation, Rochester, MN; and the Federal University of Espirito Santo (Dr Vasquez), Vitoria, Brazil.

Correspondence to: Virend K. Somers, MD, PhD, FCCP, Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905; e-mail: somers.virend@mayo.edu


Funding/Support: This publication was made possible by the National Center for Research Resources [Grant 1 UL1 RR024150] a component of the National Institutes of Health, and the National Institutes of Health’s Roadmap for Medical Research. Dr Somers was supported by the National Institutes of Health [Grant HL65176]. Dr Sert Kuniyoshi was supported by the American Heart Association [Grant 09-20069G]. These studies were also supported by a gift to the Mayo Foundation by the Respironics Foundation for Sleep and Breathing.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(1):62-67. doi:10.1378/chest.10-1722
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Background:  Impaired brachial flow-mediated dilation (FMD) is associated with risk for subsequent cardiovascular events in patients after myocardial infarction (MI). These patients often have obstructive sleep apnea (OSA). We tested the hypothesis that patients with OSA post MI will exhibit more severe impairment in FMD.

Methods:  We studied 64 patients with MI admitted to our hospital. OSA was determined using polysomnography. FMD was measured using high-resolution ultrasonography, with researchers blind to the OSA diagnosis.

Results:  The mean age was 60 ± 11 years, and the mean BMI was 29 (26, 32 kg/m2), 84% of patients were men, 39% had moderate to severe OSA (apnea-hypopnea index [AHI] > 15), and 31% of the patients had mild OSA (5 ≤ AHI < 15). FMD was severely impaired in patients with moderate to severe OSA (0.8% ± 0.7%) as compared with patients without OSA (4.7% ± 0.8%, P = .001) and with mild OSA (3.9% ± 0.8%, P = .015). Linear regression showed that FMD was associated with log nocturnal nadir oxygen saturation (minSao2) (β = 31.17, P = .0001), age (β = −0.11, P = .006). MinSao2 was an independent predictor of FMD after adjustment for possible confounders (β = 26.15, P = .001).

Conclusions:  FMD is severely impaired in patients with moderate to severe OSA post MI, which may be partially related to nocturnal hypoxemia. Patients with OSA may, therefore, be at higher risk for subsequent cardiovascular events after an MI. Identifying and treating OSA may have important implications in the long-term prognosis of patients post MI. Further studies are necessary to determine if the presence of OSA would affect the long-term occurrence of cardiovascular events after an MI.

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