Abstract
Background
Obstructive sleep apnea (OSA) is characterized by intermittent hypoxia (IH). In animal models, IH has been shown to protect the myocardium during periods of ischemia by reducing infarct size. However, this phenomenon of “ischemic preconditioning” has not been investigated among OSA patients with acute myocardial infarction (MI). This study investigates the role of OSA on MI severity as measured by cardiac enzymes, specifically troponin-T, among patients with an acute MI.
Methods
This is an observational cohort study of patients ≥18 years of age who were hospitalized with an acute MI. Each participant underwent portable sleep monitoring (Apnea Link Plus); OSA was defined as an apnea–hypopnea index ≥5/h. Multivariable regression analysis was conducted to assess the relationship between OSA and highly sensitive troponin-T levels.
Results
In our entire cohort of acute MI patients (n = 136), 77 % of the sample had evidence of sleep disordered breathing, with 35 % of the sample having OSA (i.e., an AHI >5). Higher AHI was associated with lower peak troponin-T levels in partially adjusted models (β = −0.0320, p = 0.0074, adjusted for age, gender, and race) and fully adjusted models (β = −0.0322, p = 0.0085) (additionally adjusted for smoking, hypertension, hyperlipidemia, body mass index, history of prior cardiovascular or cerebrovascular disease, diabetes and baseline admission creatinine levels). The mean value of the log-transformed peak troponin-T variable was used to dichotomize the outcome variable. In both partially (OR 0.949, CI 0.905–0.995, p = 0.03) and fully adjusted (OR 0.918, CI 0.856–0.984, p = 0.0151) logistic regression models, the OR for AHI suggests a protective effect on high troponin-T level.
Conclusions
Our study demonstrates that patients with OSA have less severe cardiac injury during an acute non-fatal MI when compared to patients without OSA. This may suggest a cardioprotective role of sleep apnea during acute MI via ischemic preconditioning.
Similar content being viewed by others
References
Collinson PO (2011) Biochemical estimation of infarct size. Heart 97:169–170
Gozal D, Lipton AJ, Jones KL (2002) Circulating vascular endothelial growth factor levels in patients with obstructive sleep apnea. Sleep 25:59–65
Imagawa S, Yamaguchi Y, Higuchi M, Neichi T, Hasegawa Y, Mukai HY, Suzuki N, Yamamoto M, Nagasawa T (2001) Levels of vascular endothelial growth factor are elevated in patients with obstructive sleep apnea—hypopnea syndrome. Blood 98:1255–1257
Lavie L, Kraiczi H, Hefetz A, Ghandour H, Perelman A, Hedner J, Lavie P (2002) Plasma vascular endothelial growth factor in sleep apnea syndrome: effects of nasal continuous positive air pressure treatment. Am J Respir Crit Care Med 165:1624–1628
Ma J, Xu Y, Zhang Z, Liu H, Xiong W, Xu S (2007) Serum level of vascular endothelial growth factor in patients with obstructive sleep apnea hypopnea syndrome. J Huazhong Univ Sci Technol Med Sci 27:157–160
Martinez D, da Silva RP, Klein C, Fiori CZ, Massierer D, Cassol CM, Bos AJ, Gus M (2012) High risk for sleep apnea in the Berlin questionnaire and coronary artery disease. Sleep Breath 16(1):89–94
Martinez D, Klein C, Rahmeier L, da Silva RP, Fiori CZ, Cassol CM, Goncalves SC, Bos AJ (2012) Sleep apnea is a stronger predictor for coronary heart disease than traditional risk factors. Sleep Breath 16(3):695–701
Mayr A, Mair J, Klug G, Schocke M, Pedarnig K, Trieb T, Pachinger O, Jaschke W, Metzler B (2011) Cardiac troponin T and creatine kinase predict mid-term infarct size and left ventricular function after acute myocardial infarction: a cardiac MR study. J Magn Reson Imaging 33:847–854
Metzler B, Hammerer-Lercher A, Jehle J, Dietrich H, Pachinger O, Xu Q, Mair J (2002) Plasma cardiac troponin T closely correlates with infarct size in a mouse model of acute myocardial infarction. Clin Chim Acta 325:87–90
Murry CE, Jennings RB, Reimer KA (1986) Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation: 1124-1136
Neckar J, Ostadal B, Kolar F (2004) Myocardial infarct size-limiting effect of chronic hypoxia persists for five weeks of normoxic recovery. Physiol Res 53:621–628
Peker Y, Carlson J, Hedner J (2006) Increased incidence of coronary artery disease in sleep apnoea: a long-term follow-up. Eur Respir J 28:596–602
Reichlin T, Hochholzer W, Bassetti S, Steuer S, Stelzig C, Hartwiger S, Biedert S, Schaub N, Buerge C, Potocki M, Noveanu M, Breidthardt T, Twerenbold R, Winkler K, Bingisser R, Mueller C (2009) Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med 361(9):858–867
Shah NA, Yaggi HK, Concato J, Mohsenin V (2010) Obstructive sleep apnea as a risk factor for coronary events or cardiovascular death. Sleep Breath 14:131–136
Steiner S, Schueller PO, Schulze V, Strauer BE (2010) Occurrence of coronary collateral vessels in patients with sleep apnea and total coronary occlusion. Chest 137:516–520
Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, Writing Group on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction (2012) Third universal definition of myocardial infarction. Circulation 50:2173–2195
Tsukamoto K, Ohara A (2006) Temporal worsening of sleep-disordered breathing in the acute phase of myocardial infarction. Circ J 70:1553–1556
Valipour A, Litschauer B, Mittermayer F, Rauscher H, Burghuber OC, Wolzt M (2004) Circulating plasma levels of vascular endothelial growth factor in patients with sleep disordered breathing. Respir Med 98:1180–1186
Weinreich G, Armitstead J, Topfer V, Wang YM, Wang Y, Teschler H (2009) Validation of ApneaLink as screening device for Cheyne–Stokes respiration. Sleep 32:553–557
Xu WQ, Yu Z, Xie Y, Huang GQ, Shu XH, Zhu Y, Zhou ZN, Yang HT (2011) Therapeutic effect of intermittent hypobaric hypoxia on myocardial infarction in rats. Basic Res Cardiol 106:329–342
Younger JF, Plein S, Barth J, Ridgway JP, Ball SG, Greenwood JP (2007) troponin-I concentration 72 h after myocardial infarction correlates with infarct size and presence of microvascular obstruction. Heart 93(12):1547–1551
Zong P, Setty S, Sun W, Martinez R, Tune JD, Ehrenburg IV, Tkatchouk EN, Mallet RT, Downey HF (2004) Intermittent hypoxic training protects canine myocardium from infarction. Exp Biol Med (Maywood) 229:806–812
Acknowledgments
Dr. Shah has funding support from the American Sleep Medicine Foundation. In addition, pilot funding for purchasing sleep monitors was provided by the Divisions of Pulmonary and Cardiology at Montefiore Medical Center.
The authors would like to express their deepest gratitude to the Department of Respiratory Therapy at Montefiore Medical Center for their assistance in the application of the portable sleep monitors for this study.
Disclosures
The authors have indicated no financial conflicts of interest. A research grant ($2,000) from Resmed was received for scoring and reviewing of sleep studies by independent reviewers with no relationship to Resmed.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Shah, N., Redline, S., Yaggi, H.K. et al. Obstructive sleep apnea and acute myocardial infarction severity: ischemic preconditioning?. Sleep Breath 17, 819–826 (2013). https://doi.org/10.1007/s11325-012-0770-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11325-012-0770-7