PURPOSE: To evaluate the clinical yield of performing a routine exercise stress study for screening coronary artery disease (CAD)in an asymptomatic moderate-to-severe obstructive sleep apnea (OSA) patients.
METHODS: We prospectively studied 200 consecutive moderate to severe OSA patients who underwent polysomnography from May 2004 to September 2007. Data on demographic characteristics, sleep and medical history, medication use and habits were obtained with the use of a standardized questionnaire before the overnight polysomnography. ECG (12 leads) and routine echocardiography were performed in all patients, and in the case of a finding of myocardial, pericardial or valvular problems, the patient was excluded from the study. We also excluded those subjects with a history of coronary disease or previous myocardial infarction and left bundle branch block on resting ECG. All patients fulfilling inclusion/exclusion criteria were recruited and underwent the exercise stress testing. Patients with a positive treadmill result were regarded as high risk patients and they underwent coronary angiography for confirmation of coronary artery disease. If the exercise stress testing result was ”suspected positive“ the patients were accepted as medium or low risk and referred for myocardial perfusion study.
RESULTS: Exerxise test was definitively positive for ischemia in 3 patients and suspected positive in 8 patients. Patients who have suspected findings underwent exercise myocardial perfusion imaging and the test was normal in all 8 patients. These patients accepted as they did not have CAD. Patients whose exercise stress test findings were suggestive for CAD underwent coronary angiography and the test showed CAD in these 3 patients. Two of the 3 patients had at least three additional risk factors for CAD and also cardiac risk factor profiles seemed more pronounced for these patients.
CONCLUSION: This findings does not support routine CAD screening by exercise stress testing for OSA patients, but there might be value in screening OSA patients who have additional risk factors for CAD.
CLINICAL IMPLICATIONS: Further large scale studies are needed to address that which asymptomatic patients with OSA should be screened for occult CAD.
DISCLOSURE: Aykut Cilli, No Financial Disclosure Information; No Product/Research Disclosure Information