Skip to main content
SpringerLink
Log in

Obstructive sleep apnea increases the risk of cardiac events after percutaneous coronary intervention: a meta-analysis of prospective cohort studies

  • Sleep Breathing Physiology and Disorders • Review
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

Recent studies have shown an association between obstructive sleep apnea (OSA) and coronary artery disease; however, the association between OSA and cardiac outcomes in patients after percutaneous coronary intervention (PCI) remains undetermined.

Methods

PubMed, EMBASE, and CENTRAL were searched from inception to July 2016 for cohort studies that followed up with patients after PCI, and evaluated their overnight sleep patterns within 1 month for major adverse cardiac events (MACEs) as primary outcomes including cardiac death, non-fatal myocardial infarction (MI), and coronary revascularization and secondary outcomes including re-admission for heart failure and stroke. Outcomes data were pooled using fixed-effect meta-analysis, and heterogeneity was assessed with the I 2 statistics. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale checklist, and publication bias was evaluated by a visual investigation of funnel plots.

Results

We identified seven pertinent studies including 2465 patients from 178 related articles. OSA was associated with MACEs (odds ratio [OR], 1.52, 95% confidence interval [CI], 1.20–1.93, I 2 = 29%), which included cardiac death (OR 2.05, 95% CI, 1.15–3.65, I 2 = 0%), non-fatal MI (OR 1.59, 95% CI, 1.14–2.23, I 2 = 15%), and coronary revascularization (OR 1.69, 95% CI, 1.28–2.23, I 2 = 0%). However, OSA was not associated with re-admission for heart failure (OR 1.71, 95% CI, 0.99–2.96, I 2 = 0%) and/or stroke (OR 1.68, 95% CI, 0.91–3.11, I 2 = 0%) according to the pooled results.

Conclusions

In patients after PCI, OSA appears to increase the risk of cardiac death, non-fatal MI, and coronary revascularization.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Bradley TD, Floras JS (2009) Obstructive sleep apnea and its cardiovascular consequences. Lancet 373:82–93

    Article  PubMed  Google Scholar 

  2. Jaffe LM, Kjekshus J, Gottlieb SS (2013) Importance and management of chronic sleep apnoea in cardiology. Eur Heart J 34:809–815

    Article  PubMed  Google Scholar 

  3. Somers VK, White DP, Amin R et al (2010) Sleep apnea and cardiovascular disease. J Am Coll Cardiol 52:182–188

    Google Scholar 

  4. Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvänne M, Scholte OP, Reimer WJ, Vrints C, Wood D, Zamorano JL, Zannad F (2012) European Guidelines on Cardiovascular Disease Prevention in Clinical Practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) developed with the special contribution of the European Association for Cardiovascular Prevention and Rehabilitation (EACPR). Eur Heart J 223:1635–1701

    Google Scholar 

  5. Lee CH et al (2016) Obstructive sleep apnea and cardiovascular events after percutaneous coronary intervention. Circulation 133:2008–2017. doi:10.1161/circulation aha.115.019392

    Article  PubMed  Google Scholar 

  6. Loo G et al (2014) Prognostic implication of obstructive sleep apnea diagnosed by post-discharge sleep study in patients presenting with acute coronary syndrome. Sleep Med 15:631–636

    Article  PubMed  Google Scholar 

  7. Meng S, Fang L, Wang CQ et al (2009) Impact of obstructive sleep apnoea on clinical characteristics and outcomes in patients with acute coronary syndrome following percutaneous coronary intervention. J Int Med Res 37:1343–1353

    Article  CAS  PubMed  Google Scholar 

  8. Zhang JJ et al (2016) Obstructive sleep apnea affects the clinical outcomes of patients undergoing percutaneous coronary intervention. Patient Preference & Adherence 10:871–878

    Google Scholar 

  9. Dtsurumi Y (2007) Impact of obstructive sleep apnea on clinical and angiographic outcomes following percutaneous coronary intervention in patients with acute coronary syndrome. Am J Cardiol 99:26–30

    Article  Google Scholar 

  10. Nakashima H et al (2015) Effects of moderate-to-severe obstructive sleep apnea on the clinical manifestations of plaque vulnerability and the progression of coronary atherosclerosis in patients with acute coronary syndrome. European Heart Journal Acute Cardiovascular Care 4:75–84

    Article  PubMed  Google Scholar 

  11. Wu X et al (2015) Treatment of OSA reduces the risk of repeat revascularization after percutaneous coronary intervention. Chest 147:708–718

    Article  PubMed  Google Scholar 

  12. Medeiros AKL, Coutinho RQ, Barros IML et al (2016) Obstructive sleep apnea is independently associated with subclinical coronary atherosclerosis among middle-aged women. Sleep and Breathing 21:77–83. doi:10.1007/s11325-016-1374-4

    Article  PubMed  Google Scholar 

  13. Weinreich G et al (2003) Association of obstructive sleep apnoea with subclinical coronary atherosclerosis. Atherosclerosis 231:191–197

    Article  Google Scholar 

  14. Ng G, Boey E, Frampton C et al (2016) Obstructive sleep apnea is associated with visit-to-visit variability in low-density lipoprotein-cholesterol in patients with coronary artery disease. Sleep and Breathing 67:1–8

    Google Scholar 

  15. Turmel J et al (2009) Relationship between atherosclerosis and the sleep apnea syndrome: an intravascular ultrasound study. Int J Cardiol 132:203–209

    Article  PubMed  Google Scholar 

  16. Tan A et al (2014) OSA and coronary plaque characteristics. Chest 145:322–330

    Article  PubMed  Google Scholar 

  17. Mozaffarian D et al (2015) Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation 131:e29–322

    Article  PubMed  Google Scholar 

  18. Somers VK et al (2008) Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. J Am Coll Cardiol 52:686–717

    Article  PubMed  Google Scholar 

  19. Aihara K, Oga T, Chihara Y et al (2013) Analysis of systemic and airway inflammation in obstructive sleep apnea. Sleep and Breathing 17:597–604

    Article  PubMed  Google Scholar 

  20. Quercioli A (2010) Inflammation accelerates atherosclerotic processes in obstructive sleep apnea syndrome (OSAS). Sleep and Breathing 14:261–269

    Article  PubMed  Google Scholar 

  21. Somers VK et al (2008) Sleep apnea and cardiovascular disease: an American Heart Association/American College Of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council On Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health). Circulation 118:1080–1111

    Article  PubMed  Google Scholar 

  22. Olafiranye O, Adedayo AM (2013) Obstructive sleep apnea and dyslipidemia: pathophysiological mechanisms. Sleep and breathing 17:445–445

    Article  PubMed  Google Scholar 

  23. Hargens TA, Guill SG, Kaleth AS et al (2013) Insulin resistance and adipose-derived hormones in young men with untreated obstructive sleep apnea. Sleep and Breathing 17:403–409

    Article  PubMed  Google Scholar 

  24. Garvey JF, Taylor CT, McNicholas WT (2009) Cardiovascular disease in obstructive sleep apnoea syndrome: the role of intermittent hypoxia and inflammation. Eur Respir J 33:1195–1205

    Article  CAS  PubMed  Google Scholar 

  25. Stroup DF et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283:2008–2012

    Article  CAS  PubMed  Google Scholar 

  26. Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of non randomized studies in meta analyses. Eur J Epidemiol 25:603–605

    Article  PubMed  Google Scholar 

  27. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188

    Article  CAS  PubMed  Google Scholar 

  28. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed  PubMed Central  Google Scholar 

  29. Higgins JP (2008) Commentary: heterogeneity in meta-analysis should be expected and appropriately quantified. Int J Epidemiol 37:1158–1160

    Article  PubMed  Google Scholar 

  30. Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in metaanalysis. Biometrics 56:455–463

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. China Heart Institute of Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China

    Hua Qu, Ming Guo, Ying Zhang & Da-zhuo Shi

  2. Graduate School of Beijing University of Traditional Chinese Medicine, Beijing, China

    Hua Qu

  3. Xiyuan Hospital, China Academy of Traditional Chinese, Beijing, China

    Hua Qu, Ming Guo, Ying Zhang & Da-zhuo Shi

  4. Graduate School of China Academy of Chinese Medical Sciences, Beijing, China

    Ming Guo

Authors
  1. Hua Qu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ming Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ying Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Da-zhuo Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Da-zhuo Shi designed the review and provided methodological perspectives; Hua Qu, Ming Guo, and Ying Zhang developed the search strategy and performed the literature search, study selection, data extraction, and data analyses. Hua Qu and Ming Guo contributed equally to this work and are co-first authors.

Corresponding author

Correspondence to Da-zhuo Shi.

Ethics declarations

Funding

This work was supported by the National Natural Science Foundation of China (no. 81030063).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was not necessary for this meta-analysis, as only identified pooled data from previously approved individual studies was used.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Comment

The question of whether or not OSA increases the risk of adverse outcome after PCI is one which has been addressed by a large number of studies. In this meta-analysis the authors show increased adverse events after PCI in those with OSA. Translating this into clinical practice is clearly of interest and with that in mind it is interesting to compare and contrast the approach of Cardiologists to defining procedural success in PCI in both stable and unstable coronary disease with the limited diagnostic and therapeutic success in sleep apnea. Simplified diagnostic methods are being incorporated into clinical pathways in OSA assessment but the greatest weakness remains adherence and efficacy monitoring which will be needed to change practice amongst Cardiologists used to more rigorous approaches to diagnosis and treatment.

Ian Wilcox

Sydney, Australia

Electronic supplementary material

ESM 1

(DOC 124 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Qu, H., Guo, M., Zhang, Y. et al. Obstructive sleep apnea increases the risk of cardiac events after percutaneous coronary intervention: a meta-analysis of prospective cohort studies. Sleep Breath 22, 33–40 (2018). https://doi.org/10.1007/s11325-017-1503-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-017-1503-8

Keywords

Search

Navigation