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32. Cardiovascular Nursing
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34. Public Health and Health Economics
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Long Term Impact of Obstructive Sleep Apnea in patients with Acute Coronary Syndrome
Session:
Painel 6-Doença Coronária 1
Speaker:
Pedro Rocha Carvalho
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Pedro Rocha Carvalho; Bebiana Conde; José Paulo Fontes; Fernando Fonseca Gonçalves; Sara Borges; José João Monteiro; Sílvia Leão; Ana Fernandes; Ilidio Moreira
Abstract
<p>Background: The prognostic significance of Obstructive Sleep Apnea (OSA) in patients with Acute Coronary Syndrome (ACS) in the contemporary era is still unclear. There are several studies that have evaluated the impact of OSA in patients with ACS. However, they all have a short follow up time. The main goal of this study was to evaluate prognostic impact of OSA and continuous positive airway pressure (CPAP) therapy in patients hospitalized with ACS for more than 10 years.</p> <p>Methods: We conducted a prospective longitudinal cohort study in which 73 patients were admitted on a cardiac intensive care unit for ACS. Cardiorespiratory sleep study and/or polysomnography were performed in all patients. CPAP was recommended if Apnea/Hypopnea Index (AHI) ≥5. OSA was defined as mild for AHI ≥5 and <15, moderate for AHI ≥15 and <30, and severe for AHI ≥30.</p> <p>The main study outcome was a composite of death for any cause, myocardial infarction and myocardial revascularization.</p> <p>Results: The median follow-up time was 135 months (IQR 122 to 144). During the study period, 8 patients of non-OSA group had at least one event: 7 deaths, 1 myocardial infarction and 1 revascularization. Four patients of mild-OSA (m-OSA) group had events: 1 death, 3 myocardial infarctions and 2 revascularizations. Twenty-one patients of moderate-to-severe OSA group suffered at least one event: 15 deaths, 4 myocardial infarctions and 9 revascularizations. Composite end point of death for any cause, myocardial infarction or myocardial revascularization occurred in 33 patients: 8 in non-OSA group, 4 in m-OSA group and 21 in moderate-to-severe-OSA group. Event-free survival time (Kaplan Meier) was significantly different between groups (log-rank, p = 0.013).</p> <p>After adjustment for gender and age, patients with moderate-to-severe OSA had 2.92 times (95% CI 1.19 to 7.12, p=0.019) the risk of incurring in death, myocardial infarction or myocardial revascularization than patients without OSA. Patients with m-OSA had the same risk as patients without OSA.</p> <p>Adherence to CPAP occurred in 14 patients (30% of those referred). During the study period, 7 (50%) compliant patients incurred in 4 death and 3 myocardial revascularizations. Eighteen (55%) patients of the noncompliant group suffered 7 deaths, 8 myocardial infarctions and 12 revascularizations. Compliance to CPAP did not reduce the risk of composite end point (Hazard ratio 0.80, 95% CI 0.34 to 1.92).</p> <p>Conclusion: OSA is an underdiagnosed disease with high prevalence in patients with ACS. After 11 years of follow up, the patients with moderate-to-severe OSA still have a great risk of incurring in death, myocardial infarction or myocardial revascularization.</p>
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