Chest
Volume 124, Issue 3, September 2003, Pages 936-941
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Clinical Investigations
SLEEP AND BREATHING
Nocturnal Oxygen Desaturation Correlates With the Severity of Coronary Atherosclerosis in Coronary Artery Disease

https://doi.org/10.1378/chest.124.3.936Get rights and content

Study objectives:

It has been suggested that sleep-disordered breathing (SDB) is a risk factor for ischemic heart disease, and may be associated with increased morbidity and mortality due to cardiovascular disease. The aim of this study was to examine the relation between nocturnal oxygen desaturation (NOD) due to SDB and the Gensini score, which is given to define the severity of coronary atherosclerosis, based on coronary angiograms findings, in patients with coronary artery disease.

Design:

We examined the NOD index (ODI) (desaturation of > 3%/events per hour) using pulse oximetry in 59 consecutive patients with coronary artery disease (ejection fraction, > 40%) that was diagnosed by coronary angiography, 30 patients with angina pectoris and 29 patients with old myocardial infarction. The Gensini score was calculated for each patient from the coronary arteriogram. The patients were classified into the following three groups according to the severity of oxygen desaturation: ODI of < 5 events per hour (group N; 16 patients); ODI of ≧ 5 but < 15 events per hour (group A; 27 patients); and ODI of ≧ 15 events per hour (group B; 16 patients). The groups then were examined for the relation between the ODI and the Gensini score.

Results:

Of the total number of patients, 72.9% had a nocturnal ODI of more than five events per hour. The Gensini score was significantly higher in groups A and B than in group N, and showed a significant positive correlation with the ODI (R = 0.45; p = 0.01) in all patients. Multiple regression analysis showed that the ODI was the most significant, independent determinant of the Gensini score among the coronary risk factors tested, and that it explained 13.4% of the variance.

Conclusion:

These findings suggest that NOD due to SDB may be an important contributor to coronary atherosclerosis in the patients with cardiovascular disease.

Section snippets

Patients

All patients with ischemic heart disease who were hospitalized at Shinshu University Hospital between June 2000 and October 2001 for the diagnosis of chest pain or for the follow-up of old myocardial infarction by cardiac catheterization were considered candidates for the present study. Fifty-nine consecutive patients with angiographically diagnosed cardiovascular disease (angina pectoris, 30 patients [23 men and 7 women]; old myocardial infarction, 29 patients [25 men and 4 women]) were

Results

Clinical characteristics and serum profiles of patients in the three study groups are summarized in Table 1. There were no significant between-group differences in age, the incidence of angina pectoris or old myocardial infarction, smoking history, or body mass index. Neither were there significant differences in the frequency of hypertension, diabetes, or hyperlipidemia, or in levels of HbAIc, triglycerides, HDL-C, or uric acid. The only significant difference seen for traditional coronary

Discussion

It has been shown that patients with cardiovascular disease have a high prevalence of SDB and of oxygen desaturation accompanied by SDB.17,18 A temporal association exists between nocturnal myocardial ischemia and sleep apnea and hypopnea or desaturation in some patients with nocturnal ST-segment depression.10 Thus, SDB may be an independent predictor of cardiovascular disease. In the present study, patients with ischemic heart disease had a high prevalence of increased NOD events (> 5 events

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