Am. J. Respir. Crit. Care Med., Volume 164, Number 10, November 2001, 1910-1913

Sleep-disordered Breathing and Coronary Artery Disease
Long-term Prognosis

THOMAS MOOE, KARL A. FRANKLIN, KARIN HOLMSTRÖM, TERJE RABBEN, and URBAN WIKLUND

Departments of Cardiology, Pulmonary Medicine and Allergology, Clinical Physiology, and Clinical Neurophysiology, Umeå University Hospital, Umeå, Sweden; and Department of Internal Medicine, Ostersund Hospital, Ostersund, Sweden

The evidence linking sleep-disordered breathing to increased mortality and cardiovascular morbidity has been conflicting and inconclusive. We hypothesized that a potential adverse effect of disordered breathing would be more obvious in patients with established vascular disease. In a prospective cohort study 408 patients aged 70 yr or younger with verified coronary disease were followed for a median period of 5.1 yr. An apnea-hypopnea index (AHI) of  10 and an oxygen desaturation index (ODI) of  5 were used as the diagnostic criteria for sleep-disordered breathing. The primary end point was a composite of death, cerebrovascular events, and myocardial infarction. There was a 70% relative increase and a 10.7% absolute increase in the primary composite end point in patients with disordered breathing defined as an ODI of  5 (risk ratio 1.70, 95% confidence interval [CI] 1.15-2.52, p = 0.008). Similarly, patients with an AHI of  10 had a 62% relative increase and a 10.1% absolute increase in the composite endpoint (risk ratio 1.62, 95% CI 1.09-2.41, p = 0.017). An ODI of  5 and an AHI of  10 were both independently associated with cerebrovascular events (hazard ratio 2.62, 95% CI 1.26-5.46, p = 0.01, and hazard ratio 2.98, 95% CI 1.43-6.20, p = 0.004, respectively). We conclude that sleep-disordered breathing in patients with coronary artery disease is associated with a worse long-term prognosis and has an independent association with cerebrovascular events.

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