OSA and depression are common and independently associated with refractory angina in patients with coronary artery disease.

Autor:	Geovanini GR; Sleep Laboratory, Pulmonary Division, University of São Paulo Medical School, São Paulo, Brazil., Gowdak LHW; Refractory Angina Research Group, University of São Paulo Medical School, São Paulo, Brazil., Pereira AC; Refractory Angina Research Group, University of São Paulo Medical School, São Paulo, Brazil., Danzi-Soares NJ; Sleep Laboratory, Pulmonary Division, University of São Paulo Medical School, São Paulo, Brazil., Dourado LOC; Refractory Angina Research Group, University of São Paulo Medical School, São Paulo, Brazil., Poppi NT; Refractory Angina Research Group, University of São Paulo Medical School, São Paulo, Brazil., Cesar LAM; Refractory Angina Research Group, University of São Paulo Medical School, São Paulo, Brazil., Drager LF; Sleep Laboratory, Pulmonary Division, University of São Paulo Medical School, São Paulo, Brazil; Hypertension Unit, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil., Lorenzi-Filho G; Sleep Laboratory, Pulmonary Division, University of São Paulo Medical School, São Paulo, Brazil. Electronic address: geraldo.lorenzi@gmail.com.
Jazyk:	angličtina
Zdroj:	Chest [Chest] 2014 Jul; Vol. 146 (1), pp. 73-80.
DOI:	10.1378/chest.13-2885
Abstrakt:	Objective: Refractory angina is a severe form of coronary artery disease (CAD) characterized by persistent angina despite optimal medical therapy. OSA and depression are common in patients with stable CAD and may contribute to a poor prognosis. We hypothesized that OSA and depression are more common and more severe in patients with refractory angina than in patients with stable CAD. Methods: We used standardized questionnaires and full polysomnography to compare consecutive patients with well-established refractory angina vs consecutive patients with stable CAD evaluated for coronary artery bypass graft surgery. Results: Patients with refractory angina (n = 70) compared with patients with stable CAD (n = 70) were similar in sex distribution (male, 61.5% vs 75.5%; P = .07) and BMI (29.5 ± 4 kg/m2 vs 28.5 ± 4 kg/m2, P = .06), and were older (61 ± 10 y vs 57 ± 7 y, P = .013), respectively. Patients with refractory angina had significantly more symptoms of daytime sleepiness (Epworth Sleepiness Scale score, 12 ± 6 vs 8 ± 5; P < .001), had higher depression symptom scores (Beck Depression Inventory score, 19 ± 8 vs 10 ± 8; P < .001) despite greater use of antidepressants, had a higher apnea-hypopnea index (AHI) (AHI, 37 ± 30 events/h vs 23 ± 20 events/h; P = .001), higher proportion of oxygen saturation < 90% during sleep (8% ± 13 vs 4% ± 9, P = .04), and a higher proportion of severe OSA (AHI ≥ 30 events/h, 48% vs 27%; P = .009) than patients with stable CAD. OSA (P = .017), depression (P < .001), higher Epworth Sleepiness Scale score (P = .007), and lower sleep efficiency (P = .016) were independently associated with refractory angina in multivariate analysis. Conclusions: OSA and depression are independently associated with refractory angina and may contribute to poor cardiovascular outcome.
Databáze:	MEDLINE
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