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Obstructive sleep apnea during rapid eye movement sleep in patients after percutaneous coronary intervention: a multicenter study

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Obstructive sleep apnea (OSA) during the rapid eye movement (REM) stage of the sleep cycle is associated with intense hypoxemia and cardiovascular instability. We characterized OSA during REM sleep in patients after percutaneous coronary intervention.

Methods

In this multicenter study, 204 patients who had undergone percutaneous coronary intervention in the prior 6 to 36 months were recruited for in-laboratory polysomnography. The primary measure was respiratory events during REM sleep. The patients were divided into 2 groups: (1) OSA during REM sleep (≥ 15 events/h) and (2) absence of OSA during REM sleep (< 15 events/h).

Results

Based on the overall apnea-hypopnea index ≥ 15, 148 patients (74.0%) had OSA. After excluding patients with failed polysomnography or REM sleep < 30 min, 163 patients formed the cohort for this analysis. OSA during REM sleep was diagnosed in 132 patients (81%). Compared with the patients without OSA during REM sleep, those with OSA during REM sleep had a higher body mass index (p = 0.003) and systolic blood pressure (p = 0.041), and a higher prevalence of diabetes mellitus (p = 0.029). Logistic regression analysis, including age, sex, diabetes mellitus, indication for percutaneous coronary intervention, and indication for multi-vessel percutaneous coronary intervention, showed that diabetes mellitus was the only independent predictor of OSA during REM sleep (odds ratio 2.83; 95% CI, 1.17 to 6.83; p = 0.021).

Conclusion

In patients treated with percutaneous coronary intervention, there was a high prevalence of OSA during REM sleep. Diabetes mellitus was an independent predictor of OSA during REM sleep.

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Acknowledgments

The authors are grateful to Easmed Pte Ltd. for their support in polysomnography.

Funding

This study was supported by a Collaborative Centre Grant and a Clinician Scientist Award from the National Medical Research Council of Singapore (award number: NMRC/CG/C006/2017 NMRC/CSA–INV/002/2015).

Author information

Authors and Affiliations

  1. Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore, 119228, Singapore

    Aye-Thandar Aung, Megan Jia-Ing Tan, Chieh-Yang Koo, Pei-Qing Xu, Pipin Kojodjojo & Chi-Hang Lee

  2. Department of Medicine, Division of Cardiology, Ng Teng Fong General Hospital, Jurong, Singapore

    William Kristanto, Chieh-Yang Koo & Pipin Kojodjojo

  3. Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore

    Calvin W. Chin

  4. NeuroSleep Center of the Philippines, Manila, Philippines

    Glenn Roldan

  5. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    As Tar Thant, Siew-Pang Chan & Chi-Hang Lee

  6. Department of Medicine, Division of Respiratory Medicine, Ng Teng Fong General Hospital, Jurong, Singapore

    Ai-Ping Chua

  7. Respiratory Department, Lleida, Catalonia and Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain

    Ferran Barbe

  8. Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore

    Chi-Hang Lee

Authors
  1. Aye-Thandar Aung
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  2. William Kristanto
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Contributions

ATA: study design, analysis, and interpretation of data; drafting and revising manuscript; and final approval. WK, MJT, CYK, CWC, and PK: concept, design, analysis, and interpretation of data; revising manuscript; and final approval. SPC: statistical analysis and interpretation of data; revising manuscript; and final approval. PQX, GR, ATT, and FB: analysis and interpretation of data; drafting and revising manuscript; and final approval. APC and CHL: concept, design, analysis, and interpretation of data; drafting and revising manuscript; and final approval.

Corresponding author

Correspondence to Chi-Hang Lee.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Aung, AT., Kristanto, W., Tan, M.JI. et al. Obstructive sleep apnea during rapid eye movement sleep in patients after percutaneous coronary intervention: a multicenter study. Sleep Breath 25, 125–133 (2021). https://doi.org/10.1007/s11325-020-02057-6

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  • DOI: https://doi.org/10.1007/s11325-020-02057-6

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