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Sleep apnea is a stronger predictor for coronary heart disease than traditional risk factors

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Abstract

Background

Sleep apnea (SA) may be linked to coronary artery disease (CAD). Both conditions have similar risk factors, confounding the analyses. Investigation of the lipid profile is routine in the adult population, even without symptoms or suspected cardiac ailment. SA, however, remains underdiagnosed even in the presence of unambiguous clinical manifestations.

Purpose

The aim of this study was to verify the association between SA and CAD, adjusting for usual CAD risk factors.

Methods

Patients who underwent diagnostic or therapeutic coronariography and portable type III polysomnography were studied. The severity of SA was determined by the apnea–hypopnea index (AHI). We measured classic CAD risk factors: fasting glucose; total, HDL, and LDL cholesterols; triglycerides; uric acid, and high-sensitivity C-reactive protein. We excluded patients older than 65 years, with body mass index higher than 40 kg/m2, with diabetes, and with history of smoking in the last year.

Results

Of 55 included patients, 28 had AHI > 14, showing an odds ratio of 8.7 for CAD. Patients without (n = 29) and with CAD (n = 26), showed AHI of, respectively, 11 ± 11 and 23 ± 14 per hour (P = 0.001). In a binary logistic regression to predict CAD, controlling for all the above risk factors, the only variables entered in the stepwise model were AHI (either as continuous or categorical variable) and uric acid.

Conclusion

In a sample without smokers, morbidly obese, or diabetic patients, AHI is the main predictor of CAD. SA should integrate the set of risk factors routinely assessed in clinical investigation for coronary disease risk stratification.

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Acknowledgments

Drs. Jorge Pinto Ribeiro and Marco Vugman Wainstein are thanked for their valuable contribution in providing data from the cineangiocoronariography.

Financial support

Students received grants from the Brazilian government through CAPES and CNPq. The main support was offered by the Research Incentive Fund (FIPE) of the Hospital de Clínicas de Porto Alegre (Porto Alegre, Rio Grande do Sul, Brazil).

Conflict of interest

The authors declare that they have no conflict of interest regarding the present study.

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Authors and Affiliations

  1. Division of Cardiology, Hospital de Clínicas de Porto Alegre (HCPA), Graduate Programs in Medical Sciences and in Cardiological Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil

    Denis Martinez & Sandro Cadaval Gonçalves

  2. Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil

    Cristini Klein & Cristiane Maria Cassol

  3. Graduate Program in Medical Sciences, UFRGS, Rua Ramiro Barcelos, 2350, Porto Alegre, RS, Brazil, 90035-903

    Laura Rahmeier

  4. Graduate Program in Cardiological Sciences, UFRGS, Rua Ramiro Barcelos, 2350, Porto Alegre, RS, Brazil, 90035-903

    Roberto Pacheco da Silva & Cintia Zappe Fiori

  5. Institute of Geriatrics and Gerontology, Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, Brazil

    Angelo Jose Goncalves Bos

Authors
  1. Denis Martinez
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  2. Cristini Klein
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  4. Roberto Pacheco da Silva
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  6. Cristiane Maria Cassol
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  7. Sandro Cadaval Gonçalves
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  8. Angelo Jose Goncalves Bos
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Corresponding author

Correspondence to Roberto Pacheco da Silva.

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Martinez, D., Klein, C., Rahmeier, L. et al. Sleep apnea is a stronger predictor for coronary heart disease than traditional risk factors. Sleep Breath 16, 695–701 (2012). https://doi.org/10.1007/s11325-011-0559-0

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  • DOI: https://doi.org/10.1007/s11325-011-0559-0

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