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• W2024043920 abstract "Identifying and treating obstructive sleep apnea (OSA) may have important implications in the long-term prognosis of patients with post myocardial infarction (MI). Currently, 42% of the patients admitted with ST-segment elevation myocardial infarction (STEMI) have undiagnosed severe OSA which bears a negative prognostic impact [[1]Lee C.H. Khoo S.M. Tai B.C. et al.Obstructive sleep apnea in patients admitted for acute myocardial infarction. Prevalence, predictors, and effect on microvascular perfusion.Chest. 2009; 135: 1488-1495Crossref PubMed Scopus (124) Google Scholar]. Therefore we read with interest the important study by Garcia-Rio F et al. [[2]Garcia-Rio F. Alonso-Fernández A. Armada E. et al.CPAP effect on recurrent episodes in patients with sleep apnea and myocardial infarction.Int J Cardiol. Jan 7 2013; https://doi.org/10.1016/j.ijcard.2012.12.015Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar] which analyze the effects of continuous positive airway pressure (CPAP) in patients with OSA and MI. This paper shows a dose-dependent risk of MI at the increase of apnea–hypopnea index (AHI) and less recurrence in those who accept CPAP treatment. However important partner contributing factors could explain these findings. First, authors acknowledge the lack of data on coronary angiography, number of diseased vessels and MI classification, all relevant features for prognosis [[3]Shah N. Redline S. Yaggi H.K. et al.Obstructive sleep apnea and acute myocardial infarction severity: ischemic preconditioning?.Sleep Breath. 2013; 17: 819-826Crossref PubMed Scopus (97) Google Scholar]. A possible selection bias could have occurred on this aspect between compliant and noncompliant patients. This is particularly relevant since data cannot be split between patients with mild and severe disease. Patients with severe OSA often have a longer history of disease and the lack of these data adds no more light on the “preconditioning” hypothesis [[3]Shah N. Redline S. Yaggi H.K. et al.Obstructive sleep apnea and acute myocardial infarction severity: ischemic preconditioning?.Sleep Breath. 2013; 17: 819-826Crossref PubMed Scopus (97) Google Scholar] of OSA and on a possible different effectiveness of the CPAP treatment between the two groups in terms of severity and progression of coronary lesions. Second, pharmacological treatment adherence is relevant, (i.e.: use of post-MI drugs, particularly antiplatelet drugs) and the patients’ noncompliant to CPAP could be less compliant to drug treatment as well, a key prognostic factor. Third, the authors focused on AMI alone, and do not analyze other major adverse cardiac events (MACE), such as cardiac death, reinfarction, angina and target vessel revascularization which are notoriously higher in patients with OSA [[4]Yumino D. Tsurumi Y. Takagi A. Suzuki K. Kasanuki H. Impact of obstructive sleep apnea on clinical and angiographic outcomes following percutaneous coronary intervention in patients with acute coronary syndrome.Am J Cardiol. 2007; 99: 26-30Abstract Full Text Full Text PDF PubMed Scopus (176) Google Scholar]. Unstable angina could be of particular interest since in the absence of a documentation of coronary artery lesions it could give an estimate of the progression of arterial coronary disease. Fourth, a stratification of OSA severity would have been really important: is CPAP treatment as effective in mild as in severe patients? What happens in patients with AHI index of > 30, myocardial infarction and recurrence after application of CPAP, compared to untreated OSA? Is a late diagnosis of OSA a relevant factor for the recurrence of MI or angina? Further studies are necessary to determine if the presence of OSA would affect the long-term occurrence of cardiovascular events after an MI [[5]Sert Kuniyoshi F.H. Singh P. Gami A.S. et al.Patients with obstructive sleep apnea exhibit impaired endothelial function alter myocardial infarction.Chest. 2011; 140: 62-67Crossref PubMed Scopus (31) Google Scholar]." @default.
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• W2024043920 date "2013-10-01" @default.
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• W2024043920 title "Recurrent acute myocardial infarction and CPAP effect in mild-severe OSA: Is an independent risk factor?" @default.
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• W2024043920 doi "https://doi.org/10.1016/j.ijcard.2013.07.102" @default.
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