Apnea obstructiva del sueño y enfermedad coronaria: de la patofisiología a las implicaciones clínicas
Obstructive sleep apnea and coronary artery disease: from pathophysiology to clinical implications.
De Torres-Alba F, Gemma D, Armada-Romero E, Rey-Blas JR, López-de-Sá E, López-Sendon JL.
Acute Cardiac Care Unit, Department of Cardiology, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain.
Pulm Med. 2013;2013:768064. doi: 10.1155/2013/768064. Epub 2013 Apr 15.
Abstract
Coronary artery disease (CAD) and obstructive sleep apnea (OSA) are both complex and significant clinical problems. The pathophysiological mechanisms that link OSA with CAD are complex and can influence the broad spectrum of conditions caused by CAD, from subclinical atherosclerosis to myocardial infarction. OSA remains a significant clinical problem among patients with CAD, and evidence suggesting its role as a risk factor for CAD is growing. Furthermore, increasing data support that CAD prognosis may be influenced by OSA and its treatment by continuous positive airway pressure (CPAP) therapy. However, stronger evidence is needed to definitely answer these questions. This paper focuses on the relationship between OSA and CAD from the pathophysiological effects of OSA in CAD, to the clinical implications of OSA and its treatment in CAD patients
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3649685/pdf/PM2013-768064.pdf
La apnea obstructiva del sueño afecta la evolución de pacientes con síndromes coronarios agudos sin elevación del S-T
Obstructive sleep apnea affects hospital outcomes of patients with non-ST-elevation acute coronary syndromes.
Correia LC, Souza AC, Garcia G, Sabino M, Brito M, Maraux M, Rabelo MM, Esteves JP.
Medical School of Bahia, Salvador/BA, Brazil. lccorreia@terra.com.br
Sleep. 2012 Sep 1;35(9):1241-5A. doi: 10.5665/sleep.2078.
Abstract
STUDY OBJECTIVE: We aimed to test the hypothesis that clinically suspected obstructive sleep apnea (OSA) independently predicts worse in-hospital outcome in patients with non-ST elevation acute coronary syndromes. DESIGN: At admission, individuals were evaluated for clinical probability of OSA by the Berlin Questionnaire. Primary cardiovascular endpoint was defined as the composite of death, nonfatal myocardial infarction, or refractory angina during hospitalization. SETTING: Coronary care unit.PATIENTS: There were 168 consecutive patients admitted with unstable angina or non-ST elevation acute myocardial infarction. MEASUREMENTS AND RESULTS: During a median hospitalization of 8 days, the incidence of cardiovascular events was 13% (12 deaths, 4 nonfatal myocardial infarctions, and 6 refractory anginas.) Incidence of the primary endpoint was 18% in individuals with high probability of OSA, compared with no events in individuals with low probability (P = 0.002). After logistic regression adjustment for the Global Registry of Acute Coronary Events (GRACE) risk score, anatomic severity of coronary disease, and hospital treatment, probability of OSA remained an independent predictor of events (odds ratio [OR] = 3.4; 95% confidence interval [CI] = 1.3 - 9.0; P = 0.015). Prognostic discrimination of the GRACE score, measured by a C-statistic of 0.72 (95% CI = 0.59-0.85), was significantly improved to 0.82 (95% CI = 0.73-0.92) after inclusion of OSA probability in the predictive model (P = 0.03). CONCLUSION: Considering the independent prognostic and incremental value of suspected OSA, this condition may represent an aggravating factor for patients with non-ST elevation acute coronary syndrome.
KEYWORDS:
Acute coronary syndromes, myocardial infarction, obstructive sleep apnea, prognosis, unstable angina
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3413801/pdf/aasm
.35.9.1241.pdf
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Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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