Chest
Volume 117, Issue 6, June 2000, Pages 1597-1602
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Clinical Investigations
SLEEP
Sleep-Disordered Breathing and Myocardial Ischemia in Patients With Coronary Artery Disease

https://doi.org/10.1378/chest.117.6.1597Get rights and content

Study objectives

To examine the occurrence of nocturnal myocardial ischemia and its relationship to sleep-disordered breathing (apneas and oxygen desaturations) in randomly selected men and women undergoing coronary angiography because of angina pectoris.

Design

An observational study using an overnight sleep study and Holter recording to examine disordered breathing (oxyhemoglobin desaturations ≥ 4% and apnea-hypopneas), heart rates, and ST-segment depressions (≥ 1 mm, ≥ 1 min).

Setting

University Hospital, Umeå, a teaching hospital in northern Sweden.

Patients

One hundred thirty-two men and 94 women referred for consideration of coronary intervention were randomly included, by lot.

Results

ST-segment depressions occurred in 59% (134 of 226) of the patients, and nocturnal ST-segment depressions occurred in 31% (69 of 226). A ST-segment depression occurred within 2 min after an apnea-hypopnea or desaturation in 12% (27 of 226) of patients. This temporal association was seen in 19% of nocturnal ST-segment depressions (71 of 366), more frequently in men (p < 0.01) and in more severely disordered breathing (p < 0.001). Most of these ST-segment depressions were preceded by a series of breathing events: three or more apnea-hypopneas or desaturations or both in 70% (50 of 71).

Conclusion

Episodes of nocturnal myocardial ischemia are common in patients with angina pectoris. However, a temporal relationship between sleep-disordered breathing and myocardial ischemia is present only in a minority of the patients, but occurs more frequently in men and in more severely disordered breathing.

Section snippets

Patients

Men and women ≤70 years old referred for coronary angiography because of disabling angina pectoris were included in the study. Participants were randomly selected, by lot, from all eligible patients that day for an overnight sleep study. The presence of coronary disease was verified before inclusion.

The study was approved by the institutional ethics committee, and all subjects gave informed consent.

Sleep Studies

The following variables were recorded during 1 night of sleep in the hospital: oronasal airflow

Results

One hundred forty-four men and 106 women ≤ 70 years old were included. Sixteen patients (5 men, 11 women) refused to participate. After exclusions for technical failures, complete analysis of oxygen desaturation and Holter recording were obtained in 132 men and 94 women. Complete apnea analysis was obtained in 127 men and 92 women. All patients had stable angina pectoris in Canadian Cardiovascular Society class II (16%; n = 36) or III (84%; n = 190).10

One-vessel disease was found in 19%,

Discussion

Although disordered breathing is common in patients with symptomatic coronary disease,5, 6 published data about the relationship between nocturnal oxygen desaturations or apneas and myocardial ischemia are based on small and selected patient groups.7, 1112, 13 In one study of 10 men with nocturnal angina and angiographically verified coronary disease, 5 had apneas or hypopneas within 90 s before ischemia was detected using computerized vectorcardiography.7 When Holter monitoring was performed

ACKNOWLEDGMENT

We are grateful to Rolf Hörnsten for his skillful work with the ECG recordings.

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This study was supported by grants from the Swedish National Association for Heart and Lung Patients, the Swedish Heart Lung Foundation, the Norrland Heart Fund, and the Medical Faculty, Umeå University.

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