A new study found that patients treated with percutaneous coronary intervention experience a high prevalence of obstructive sleep apnea (OSA) during rapid eye movement (REM) sleep. Diabetes mellitus was an independent predictor of OSA during REM sleep, according to an American Thoracic Society press release.

OSA during the REM sleep cycle is associated with intense hypoxemic insult and cardiovascular instability. The researchers characterized OSA during REM sleep in patients after recent percutaneous coronary intervention.

A total of 204 patients who had undergone percutaneous coronary intervention in the prior 6 to 36 months were recruited from 3 tertiary hospitals in Singapore for an in-hospital polysomnography for the study. The primary measure was REM apnea-hypopnea index (AHI), which was calculated as the number of apnea and hypopnea per hour of REM sleep.

The patients were divided into 2 groups: OSA during REM sleep and absence of OSA during REM sleep. Patients with failed polysomnography or REM sleep for less than 30 minutes, which precluded precise REM AHI measurement, were excluded and 163 patients formed the cohort for this analysis, according to the study authors.

The indication for percutaneous coronary intervention was acute coronary syndrome in 113 patients, with OSA during REM sleep diagnosed in 132 patients. Participants with OSA during REM sleep had higher body mass index, systolic blood pressure, and prevalence of diabetes mellitus compared with patients with absence of OSA during REM sleep.

Further, patients with OSA during REM sleep experienced lower oxygen saturation and longer time with oxygen saturation. There were no significant differences in angiographic and coronary intervention characteristics, medication upon discharge, left ventricular dimension, and ejection fraction between the 2 groups, according to the study authors.

Compared with patients with absence of OSA during REM sleep, those with OSA during REM sleep had a significantly lower E/A ratio. A logistic regression analysis, including age, sex, diabetes mellitus, indication for percutaneous coronary intervention, and multi-vessel percutaneous coronary intervention, showed that diabetes mellitus was the only independent predictor of OSA during REM sleep.

The overall AHI among the 132 patients with OSA during REM sleep was less than 15 events per hour in 21 patients, suggesting that these patients would have been missed if conventional diagnostic criteria had been used. None of the 132 patients in the OSA during REM sleep had AHI lower than 5 events per hour, according to the study authors.

REFERENCE
Aung AT, Kristanto W, Tan MJI, et al. Obstructive Sleep Apnea During Rapid Eye Movement Sleep in Patients After Percutaneous Coronary Intervention: A Multicenter Study. ATS. https://www.abstractsonline.com/pp8/#!/8998/presentation/10464.