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Original Research: Sleep Disorders |

Impact of OSA on Cardiovascular Events After Coronary Artery Bypass SurgeryOSA and Coronary Artery Bypass Grafting

Carlos Henrique G. Uchôa, PT; Naury de Jesus Danzi-Soares, PhD, RN; Flávia S. Nunes, MD, PhD; Altay A. L. de Souza, PhD; Flávia B. Nerbass, PT; Rodrigo P. Pedrosa, MD, PhD; Luiz Antonio M. César, MD, PhD; Geraldo Lorenzi-Filho, MD, PhD; Luciano F. Drager, MD, PhD
Author and Funding Information

From the Sleep Laboratory, Pulmonary Division (Drs Uchôa, Danzi-Soares, Nunes, Nerbass, and Lorenzi-Filho), the Hypertension Unit (Drs Uchôa and Drager), and the Clinical Unit of Chronic Coronary Heart Disease (Dr César), Heart Institute (InCor), and the Hypertension Unit, Renal Division (Dr Drager), University of São Paulo Medical School, São Paulo; the Physicobiology Department (Dr de Souza), Federal University, São Paulo; and the Sleep and Heart Laboratory (Dr Pedrosa), Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Pernambuco, Brazil.

CORRESPONDENCE TO: Luciano F. Drager, MD, PhD, Hypertension Unit, Heart Institute (InCor), University of São Paulo Medical School, Avenida Dr Eneas Carvalho de Aguiar, 44, CEP 05403-900 São Paulo, Brazil; e-mail: luciano.drager@incor.usp.br


FUNDING/SUPPORT: This study was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) and Fundação Zerbini, Brazil. Dr Uchôa is funded by CAPES/CNPq. Dr Drager is funded by a Young Investigator Award from FAPESP [Grant 2012/02953-2].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(5):1352-1360. doi:10.1378/chest.14-2152
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BACKGROUND:  The impact of OSA on new cardiovascular events in patients undergoing coronary artery bypass graft (CABG) surgery is poorly explored.

METHODS:  Consecutive patients referred for CABG underwent clinical evaluation and standard polysomnography in the preoperative period. CABG surgery data, including percentage of off-pump and on-pump CABG, number of grafts, and intraoperative complications, were collected. The primary end point was major adverse cardiac or cerebrovascular events (MACCEs) (combined events of all-cause death, myocardial infarction, repeated revascularization, and cerebrovascular events). Secondary end points included individual MACCEs, typical angina, and arrhythmias. Patients were evaluated at 30 days (short-term) and up to 6.1 years (long term) after CABG.

RESULTS:  We studied 67 patients (50 men; mean age, 58 ± 8 years; mean BMI, 28.5 ± 4.1 kg/m2). OSA (apnea-hypopnea index ≥ 15 events/h) was present in 56% of the population. The patients were followed for a mean of 4.5 years (range, 3.2-6.1 years). No differences were observed in the short-term follow-up. In contrast, MACCE (35% vs 16%, P = .02), new revascularization (19% vs 0%, P = .01), episodes of typical angina (30% vs 7%, P = .02), and atrial fibrillation (22% vs 0%, P = .0068) were more common in patients with than without OSA in the long-term follow-up. OSA was an independent factor associated with the occurrence of MACCE, repeated revascularization, typical angina, and atrial fibrillation in the multivariate analysis.

CONCLUSIONS:  OSA is independently associated with a higher rate of long-term cardiovascular events after CABG and may have prognostic and economic significance in CABG surgery.

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