Sleep Laboratory, Pulmonary Division, University of São Paulo Medical School, São Paulo; Hypertension Unit, University of São Paulo Medical School, São Paulo.
Sleep Laboratory, Pulmonary Division, University of São Paulo Medical School, São Paulo.
Chest. 2015 May;147(5):1352-1360. doi: 10.1378/chest.14-2152.
The impact of OSA on new cardiovascular events in patients undergoing coronary artery bypass graft (CABG) surgery is poorly explored.
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.
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.
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.
阻塞性睡眠呼吸暂停（OSA）对接受冠状动脉旁路移植术（CABG）的患者新发心血管事件的影响尚未得到充分探讨。
连续接受 CABG 治疗的患者在术前接受临床评估和标准多导睡眠图检查。收集 CABG 手术数据，包括非体外循环和体外循环 CABG 的比例、移植血管数量和术中并发症等。主要终点是主要不良心脏或脑血管事件（MACCE）（全因死亡、心肌梗死、再次血运重建和脑血管事件的复合事件）。次要终点包括各个 MACCE、典型心绞痛和心律失常。患者在 CABG 后 30 天（短期）和 6.1 年（长期）进行评估。
我们研究了 67 例患者（50 例男性；平均年龄 58 ± 8 岁；平均 BMI 28.5 ± 4.1 kg/m2）。56%的患者存在 OSA（呼吸暂停低通气指数≥15 次/小时）。患者平均随访 4.5 年（范围 3.2-6.1 年）。短期随访中未观察到差异。相反，在长期随访中，OSA 患者的 MACCE（35%比 16%，P=0.02）、新的血运重建（19%比 0%，P=0.01）、典型心绞痛发作（30%比 7%，P=0.02）和心房颤动（22%比 0%，P=0.0068）的发生率高于无 OSA 患者。多变量分析显示，OSA 是 MACCE、再次血运重建、典型心绞痛和心房颤动发生的独立相关因素。
OSA 与 CABG 后长期心血管事件的发生率独立相关，可能对 CABG 手术具有预后和经济意义。
