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Original Research: SLEEP MEDICINE |

Obstructive Sleep Apnea in Patients Admitted for Acute Myocardial Infarction: Prevalence, Predictors, and Effect on Microvascular Perfusion

Chi-Hang Lee, MBBS; See-Meng Khoo, MBBS; Bee-Choo Tai, PhD; Eric Y. Chong, MBBS; Cindy Lau, BSc; Yemon Than; Dong-Xia Shi; Li-Ching Lee, MBBS; Anand Kailasam, BSc; Adrian F. Low, MBBS; Swee-Guan Teo, MBBS; Huay-Cheem Tan, MBBS
Author and Funding Information

*From the Departments of Medicine (Drs. C.-H. Lee, Low, and Tan, and Ms. Lau, Ms. Than, and Ms. Shi) and Community, Occupational and Family Medicine (Dr. Tai), Yong Loo Lin School of Medicine, National University of Singapore; and The Heart Institute (Drs. C.-H. Lee, Chong, L.-C. Lee, Low, Teo, and Tan, and Mr. Kailasam) and Department of Medicine (Dr. Khoo), National University Hospital, Singapore.

Correspondence to: Chi-Hang Lee, MBBS, Cardiac Department, National University Hospital, 5, Lower Kent Ridge Rd, Singapore 119074; e-mail: mdclchr@nus.edu.sg


The authors have no conflicts of interest to disclose.

Source of funding: Cardiac Department Fund, National University Hospital, Singapore.

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


© 2009 American College of Chest Physicians


Chest. 2009;135(6):1488-1495. doi:10.1378/chest.08-2336
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Background:  We investigated the prevalence and predictors of obstructive sleep apnea (OSA) in patients admitted to the hospital for acute myocardial infarction and whether OSA has any association with microvascular perfusion after primary percutaneous coronary intervention (PCI).

Methods:  Recruited patients were scheduled to undergo an overnight sleep study between 2 and 5 days after primary PCI. An apnea-hypopnea index (AHI) of ≥ 15 was considered diagnostic of OSA. Impaired microvascular perfusion after primary PCI was defined as an ST-segment resolution of ≤ 70%, myocardial blush grade 0 or 1, or a corrected Thrombolysis in Myocardial Infarction (TIMI) [antegrade flow scale] frame count > 28.

Results:  Sleep study was performed in 120 patients and completed in 105 patients (study cohort, mean age 53 ± 10 years, male 98%) with uncomplicated myocardial infarction. An AHI was ≥ 15 in 69 patients (OSA-positive), giving a prevalence of 65.7%. Diabetes mellitus was found to be a significant risk factor for OSA (odds ratio, 2.86; 95% confidence interval, 1.06 to 8.24; p = 0.033). There were no differences between OSA-positive and OSA-negative groups with regard to the percentage of patients with ≤ 70% ST-segment resolution (73% vs 64%, respectively; p = 0.411), myocardial blush grade 0 or 1 (39.1% vs 38.9%, respectively; p = 1.000), or corrected TIMI frame count > 28 (21.7% vs 25.0%, respectively; p = 0.807).

Conclusions:  We found a high prevalence of previously undiagnosed OSA in patients admitted with acute myocardial infarction. Diabetes mellitus was independently associated with OSA. No evidence indicated that OSA is associated with impaired microvascular perfusion after primary PCI.

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