EurekaMag.com logo
+ Site Statistics
References:
53,869,633
Abstracts:
29,686,251
+ Search Articles
+ Subscribe to Site Feeds
EurekaMag Most Shared ContentMost Shared
EurekaMag PDF Full Text ContentPDF Full Text
+ PDF Full Text
Request PDF Full TextRequest PDF Full Text
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter
Follow on LinkedInFollow on LinkedIn

+ Translate

Sleep-related myocardial ischemia and sleep structure in patients with obstructive sleep apnea and coronary heart disease



Sleep-related myocardial ischemia and sleep structure in patients with obstructive sleep apnea and coronary heart disease



Chest 111(2): 387-393



Study objectives: Patients with coronary heart disease (CHD) and obstructive sleep apnea may have an increased cardiac risk due to nocturnal myocardial ischemia triggered by apnea-associated oxygen desaturation. Sleep structure in patients with obstructive sleep apnea is fragmented by activation of the central nervous system (CNS) (arousal) due to obstructive apneas. Nocturnal myocardial ischemia may lead to activation of the CNS as well. Patients: Fourteen patients with obstructive sleep apnea and CHD disease and seven patients suffering from obstructive sleep apnea without CHD were studied. Overnight sleep studies and simultaneous six-lead ECG recordings were performed. In addition, sleep studies and ECG recordings were performed with administration of a sustained-release nitrate in these patients in a double-blinded crossover design. Results: Analysis of three nights' recordings revealed 144 episodes of nocturnal myocardial ischemia in six subjects. Five patients had underlying CHD and one patient exhibited diffuse wall defects of the coronary arteries; also, 85.4% of ischemic episodes were concomitant with apneas and oxygen desaturation gt 3%, and 77.8% of ischemic episodes occurred during rapid eye movement (REM) sleep, although total amount of REM sleep was only 18% of total sleep time. Mean oxygen saturation was significantly lower (p lt 0.05) during apnea-associated ischemic episodes than during nonapnea-associated ischemia (77.3% vs 93.1%). Nitrate administration did not reduce ischemic episodes. Sleep architecture (macrostructure) exhibited a reduction in sleep stages non-REM 3 and 4 and REM sleep. Comparing the microstructure of sleep (arousals) within episodes with and without ischemia but similar criteria like sleep stage, apnea activity, and oxygen saturation, we found significantly more (p lt 0.01) and severe (p lt 0.001) arousals during periods with myocardial ischemia than during control episodes. In addition, microstructure of sleep was disturbed by myocardial ischemia itself in absence of apneas. Conclusion: It is concluded that patients with CHD and obstructive sleep apnea are endangered by apnea-associated ischemia and that these ischemic episodes lead to activation of the CNS and additional fragmentation of sleep. Patients with nocturnal ischemia should be screened for underlying sleep apnea even if nitrate therapy fails.

(PDF emailed within 0-6 h: $19.90)

Accession: 009425530

Download citation: RISBibTeXText

PMID: 9041987

DOI: 10.1378/chest.111.2.387



Related references

Obstructive sleep apnea in epilepsy patients: the Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ) is a useful screening instrument for obstructive sleep apnea in a disease-specific population. Sleep Medicine 4(6): 517-521, 2003

Markers of Myocardial Ischemia in Patients with Obstructive Sleep Apnea and Coronary Artery Disease. Pulmonary Medicine 2015: 621450-621450, 2016

Ask the doctors. I have always had a snoring problem and recently underwent a sleep test at the insistence of my wife. I was diagnosed as having sleep apnea. We have read about the connection between sleep apnea and heart disease, and now we are both concerned. Will treating my sleep apnea reduce my heart risk?. Harvard Heart Letter 23(5): 2-2, 2013

Obstructive sleep apnea in epilepsy patients Further validation of the Sleep Apnea Scale of the Sleep Disorders Questionnaire in a disease-specific population. Sleep (Rochester) 24(Abstract Supplement): A271-A272, April 15, 2001

Function and modulation of premotor brainstem parasympathetic cardiac neurons that control heart rate by hypoxia-, sleep-, and sleep-related diseases including obstructive sleep apnea. Progress in Brain Research 212: 39-58, 2015

Evidence that the degree of obstructive sleep apnea may not increase myocardial ischemia and arrhythmias in patients with stable coronary artery disease. Clinics 64(3): 223-230, 2010

Nocturnal myocardial ischemia and cardiac arrhythmia in patients with sleep apnea with and without coronary heart disease. Klinische Wochenschrift 69(11): 474-482, 1991

Is obstructive sleep apnea a risk factor for myocardial infarction and cardiac arrhythmias in patients with coronary heart disease ?. Sleep (Rochester) 19(4): 283-286, 1996

Is obstructive sleep apnea (OSA) a risk factor for myocardial infarction and cardiac arrhythmias in patients with coronary heart disease (CHD)?. Sleep 19(4): 283-286, 1996

Increased ventricular premature contraction frequency during rem sleep in patients with coronary artery disease and obstructive sleep apnea. Indian Pacing and Electrophysiology Journal 8(4): 258-267, 2008

Obstructive Sleep Apnea in a Severely Obese Child With Combined Central Sleep Apnea and Sleep-Related Hypoventilation Disorder Caused by a Medullary Tumor. Journal of Clinical Sleep Medicine 14(6): 1071-1074, 2018

Markers of Myocardial Ischemia in Patients With Coronary Artery Disease and Obstructive Sleep Apnea: Effect of Continuous Positive Airway Pressure Therapy. Clinical Cardiology 38(8): 462-468, 2016

Can we truly change from polysomnography to polygraphy in obstructive sleep apnea? A comparison between these to levels of sleep studies in a population of patients with obstructive sleep apnea. Sleep Medicine 40: E258-E259, 2017

Anxiety as a mediator of the relationship between personality and subjective sleep quality in coronary artery disease patients with and without obstructive sleep apnea. European Neuropsychopharmacology 26: S634-S635, 2016

Type D Personality and Sleep Quality in Coronary Artery Disease Patients With and Without Obstructive Sleep Apnea: Mediating Effects of Anxiety and Depression. International Journal of Behavioral Medicine 25(2): 171-182, 2018