OBSTRUCTIVE SLEEP APNEA IN PATIENTS WITH CORONARY ATERY DISEASE OBSTRUCTIVE SLEEP APNEA IN PATIENTS WITH CORONARY ATERY DISEASE By Ahmad Younis Professor of Thoracic Medicine Department Mansoura Faculty of Medicine Ahmad Younis Professor of Thoracic Medicine Department Mansoura Faculty of Medicine

OSA is an emerging health challenge partially because of its strong association with many cardiovascular disorders but more importantly due to its individual recognition as an established cardiac risk factor OSA is an emerging health challenge partially because of its strong association with many cardiovascular disorders but more importantly due to its individual recognition as an established cardiac risk factor. OSA is a relatively under-diagnosed condition and hence, the majority of OSA patients would have developed a cardiovascular condition before a formal diagnosis of OSA is made.

Aim of the work The aim of this work was to determine the frequency of OSA in patients with CAD and illustrate the correlation of severity of OSA ( AHI and nocturnal O2 desaturation indices ) to severity of CAD (as evidenced by coronary angiography).

Subjects and methods Thirty patients with CAD as evidenced by stenosis of coronary artery angiography were subjected to :- 1- Thorough history taking and clinical examination 2- ECG and echocardiogram 3- Laboratory investigation include arterial blood gases,blood sugar, lipogram,liver and kidney function tests 4- Full night Polysomonography (PSG) for objective diagnosis of OSA

Quantitative assessment of the degree of stenosis of coronaries were done by Gensini score.Reduction of 25% 50% 75% 90% 99% and complete occlusion were given score 1,2,4,8,16 and32. Each principal vascular segment was assigned a multiplier in accordance of the myocardial area supplied by that segment. The left main coronary multiplied by 5, the proximal segment of the left anterior descending coronary artery multiplied by 2.5,the proximal segment of the circumflex artery multiplied by 2.5,the midsegment of the LAD multiplied by 1.5, the right coronary artery,the distal segment of LAD, the posterolateral artery and the obtuse marginal are multiplied by 1 and others multiplied by 0.5.

Results

Table (1): OSA in studied cases with CAD N% CAD with OSA (AHI>5/hour) 1240 CAD without OSA (AHI <5 /hour) 1860 Total OSA obstructive sleep apnea AHI apnea hypopnea index CAD coronary atherosclerotic disease

Table (2): Demographic data of CAD with OSA VS CAD without OSA CAD with OSA N = 12 CAD without OSA N = 18 Statistic 1- Mean Age (years) ± ± 2.659t = p > Mean Neck circumference (cm) 43 ± ± 1.138t = p < Mean BMI (Kg/m2) 32.5 ± ± 2.2t = p < Male ratio (N/ %) 9 (75%)15 (83%)  2 = p = BMI body mass index

Table (3): Cardiovascular risk factors in CAD with OSA VS CAD without OSA Cardiovascular risk factors CAD with OSA N (%) CAD without OSA N (%) Statistic 1- HTN 6 (50%)6 (33.3%)  2 = p = Dyslipedemia 3 (25%)6 (33.3%)  2 = p = Smoking 6 (50%)12 (66.7%)  2 = p = DM 3 (25%)3 (16.7%)  2 = p = Male ratio 9 (75%)15 (83%)  2 = p = HTN hypertension, DM diabetes melitus

Table (4): Polysomonographic parameters in CAD with OSA VS CAD without OSA CAD with OSA Mean ± SD CAD without OSA Mean ± SD Statistic 1-AHI ± ± 0.786t = 53.2, p < Desaturation index 20 ± ± 3.2t =10.113, p < Average duration Sao2<90% (seconds) ± ± 4.116t =7.719, p < %total sleep time Sao2<90% ± ± 0.617t = , p < Minimum Sao2% 81 ± ± 0.707t = , p < Arousal index 39.5 ± ± 1.917t = , p <0.001

Table (5): Quantitation of stenosis of coronary arteries in patients with CAD with OSA VS CAD without OSA CAD with OSA Mean ± SD CAD without OSA Mean ± SD Statistic 1-Number of coronary vessel stenosis 2.25 ± ± 0.485t = 5.206, p < Gensini score31.5 ± ± 2.572t =16.479, p <0.001

Table (6): Correlation of Polysomonographic parameters with the severity of stenosis of coronary angiogram Severity of stenosis of coronary angiogram Correlation Coefficient (r)P value 1-AHI 2-Desaturation index 3-Average duration Sao2<90% 4-% total sleep time Sao2<90% 5-Minimum Sao2% 6-Arousal index – < <

conclusion

From this study we can conclude that the frequency of OSA in CAD is high (40%) OSA is a significant risk factor for CAD as evidenced by significant positive correlation between AHI and nocturnal O2 desaturation indices with the degree of coronary artery stenosis ( Gensini score ). Great attention should be paid to the screening of OSA in patients with CAD in order to improve CAD and its prognosis. The timely diagnosis and treatment of OSA should be taken into account in secondary prevention of CAD

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