Increased Risk of Stroke in Patients With Coronary Artery Disease and Sleep Apnea

Author:

Valham Fredrik1,Mooe Thomas1,Rabben Terje1,Stenlund Hans1,Wiklund Urban1,Franklin Karl A.1

Affiliation:

1. From the Department of Respiratory Medicine (F.V., K.A.F.), Umeå University Hospital, Umeå, Sweden; Department of Internal Medicine, Östersund Hospital, Östersund, Sweden, and Department of Public Health and Clinical Medicine, Heart Centre, Umeå University Hospital, Umeå, Sweden (T.M.); Department of Clinical Neurophysiology (T.R.), Umeå University Hospital, Umeå, Sweden; Department of Epidemiology and Public Health (H.S.), Umeå University, Umeå, Sweden; and Department of Biomedical...

Abstract

Background— The effect of sleep apnea on mortality and cardiovascular morbidity is mainly unknown. We aimed to study whether sleep apnea is related to stroke, death, or myocardial infarction in patients with symptomatic coronary artery disease. Methods and Results— A total of 392 men and women with coronary artery disease referred for coronary angiography were examined by use of overnight sleep apnea recordings. Sleep apnea, defined as an apnea-hypopnea index ≥5, was recorded in 54% of the patients. All patients were followed up prospectively for 10 years, and no one was lost to follow-up. Stroke occurred in 47 (12%) of 392 patients during follow-up. Sleep apnea was associated with an increased risk of stroke, with an adjusted hazard ratio of 2.89 (95% confidence interval 1.37 to 6.09, P =0.005), independent of age, body mass index, left ventricular function, diabetes mellitus, gender, intervention, hypertension, atrial fibrillation, a previous stroke or transient ischemic attack, and smoking. Patients with an apnea-hypopnea index of 5 to 15 and patients with an apnea-hypopnea index ≥15 had a 2.44 (95% confidence interval 1.08 to 5.52) and 3.56 (95% confidence interval 1.56 to 8.16) times increased risk of stroke, respectively, than patients without sleep apnea, independent of confounders ( P for trend=0.011). Death and myocardial infarction were not related to sleep apnea. Intervention in the form of coronary artery bypass grafting or percutaneous coronary intervention was related to a longer survival but did not affect the incidence of stroke. Conclusions— Sleep apnea is significantly associated with the risk of stroke among patients with coronary artery disease who are being evaluated for coronary intervention.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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