Chest
Original Research: Sleep DisordersImpact of OSA on Cardiovascular Events After Coronary Artery Bypass Surgery
Section snippets
Participants
We studied consecutive patients with severe coronary artery disease (CAD) over 40 years of age referred for CABG at the Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.3 This is a follow-up study from a previous investigation devoted to validating the diagnosis of OSA with portable sleep monitors among consecutive patients referred for elective CABG.3 Details on patient recruitment were previously reported.3 Patients were excluded if they had a previous
Preoperative Clinical Evaluation
All participants underwent a detailed history and physical examination, including anthropometric and BP measurements. All subjects underwent an overnight standard polysomnography performed at the sleep laboratory as previously described.3 Hypopnea was defined as a 50% airflow lasting ≥ 10 s associated with oxygen desaturation of > 3% or with an arousal. Apnea was defined when cessation of airflow lasted ≥ 10 s and was further classified based on the presence or absence of respiratory effort as
Follow-up
Percentage of off-pump and on-pump CABG, on-pump time (minutes), number of grafts, and intraoperative complications (see standard definitions in e-Appendix 1) were recorded. In the postoperative setting, all patients were initially monitored in the ICU. As previously described,13 blood samples for serum creatinine kinase MB and troponin determination were collected prior to surgery and every 6 h after surgery, until the peak elevation was determined. We followed up all participants during the
Statistical Analysis
Data were analyzed with SPSS 18.0 (IBM Corporation). After checking normality with the Kolmogorov-Smirnov test, the results were expressed as mean ± SD, median (interquartile range), or percentage, when appropriate. Wilcoxon signed-rank test and paired Student t or Mann-Whitney U tests were used for independent samples, and the χ2 test was used to compare the variables of frequency between patients with and without OSA. The time to the first occurrence of any one of the components of the
Results
We prospectively evaluated 100 patients who underwent elective CABG. None had a previous history of arrhythmias. Sixty-seven patients (50 men) composed the final sample (Fig 1). The baseline characteristics of the entire population are presented in Table 1. The study population was predominantly middle-aged, overweight, and white. The frequency of patients with OSA was 56% (mean AHI, 23.3 ± 20.3 events/h of sleep).
Compared with patients without OSA, patients with OSA had significantly higher
Discussion
To our knowledge, this is the first study to evaluate the impact of OSA on short- and long-term cardiovascular events after CABG. We extend our previous findings that OSA is extremely common in patient candidates for CABG.3 Contrary to our initial hypothesis, we found no short-term differences in cardiovascular events in patients with and without OSA. However, in the long-term follow-up, the rate of MACCE (primary outcome) was higher in patients with than without OSA. This combined end point is
Acknowledgments
Author contributions: L. F. D. and C. H. G. U. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. N. d. J. D.-S., F. S. N., F. B. N., and R. P. P. contributed substantially to the study design, data collection, data interpretation, and the writing of the manuscript; and C. H. G. U., A. A. L. d. S., L. A. M. C., G. L.-F., and L. F. D. contributed substantially to the study design, data analysis and
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FUNDING/SUPPORT: This study was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) and Fundação Zerbini, Brazil. Dr Uchôa is funded by CAPES/CNPq. Dr Drager is funded by a Young Investigator Award from FAPESP [Grant 2012/02953-2].
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