This Article Full Text Full Text (PDF) All Versions of this Article: 118/9/955    most recent CIRCULATIONAHA.108.783290v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Valham, F. Articles by Franklin, K. A. Search for Related Content PubMed PubMed Citation Articles by Valham, F. Articles by Franklin, K. A. Related Collections Other diagnostic testing Risk Factors for Stroke Chronic ischemic heart disease

(Circulation. 2008;118:955-960.)
© 2008 American Heart Association, Inc.

Stroke

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

A 10-Year Follow-Up

Fredrik Valham, MD; Thomas Mooe, MD, PhD; Terje Rabben, MD; Hans Stenlund, PhD; Urban Wiklund, PhD; Karl A. Franklin, MD, PhD

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 Engineering & Informatics (U.W.), Umeå University Hospital, Umeå, Sweden.

Correspondence to Assistant Professor Karl A. Franklin, MD, Department of Respiratory Medicine, University Hospital, SE-901 85 Umeå, Sweden. E-mail Karl.Franklin{at}Lung.umu.se

Received April 7, 2008; accepted June 27, 2008.

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.

---

 

CLINICAL PERSPECTIVE

This article has been cited by other articles:

				I. Wilcox and C. Semsarian Obstructive sleep apnea a respiratory syndrome with protean cardiovascular manifestations. J. Am. Coll. Cardiol., November 3, 2009; 54(19): 1810 - 1812. [Full Text] [PDF]

				R. Mehra, K. L. Stone, P. D. Varosy, A. R. Hoffman, G. M. Marcus, T. Blackwell, O. A. Ibrahim, R. Salem, and S. Redline Nocturnal Arrhythmias Across a Spectrum of Obstructive and Central Sleep-Disordered Breathing in Older Men: Outcomes of Sleep Disorders in Older Men (MrOS Sleep) Study Arch Intern Med, June 22, 2009; 169(12): 1147 - 1155. [Abstract] [Full Text] [PDF]

				M. S. Simmons and G. T. Clark The Potentially Harmful Medical Consequences of Untreated Sleep-Disordered Breathing: The Evidence Supporting Brain Damage J Am Dent Assoc, May 1, 2009; 140(5): 536 - 542. [Abstract] [Full Text] [PDF]

				P. Jennum and R. L. Riha Epidemiology of sleep apnoea/hypopnoea syndrome and sleep-disordered breathing Eur. Respir. J., April 1, 2009; 33(4): 907 - 914. [Abstract] [Full Text] [PDF]

				L. F. Drager, L. A. Bortolotto, E. M. Krieger, and G. Lorenzi-Filho Additive Effects of Obstructive Sleep Apnea and Hypertension on Early Markers of Carotid Atherosclerosis Hypertension, January 1, 2009; 53(1): 64 - 69. [Abstract] [Full Text] [PDF]