Obstructive Sleep Apnea as a Key Contributor to Mental Stress-Induced Myocardial Ischemia in Female Angina Patients with No Obstructive Coronary Artery Disease

Figures & data

Table 1 Baseline Characteristics of Patients in MSIMI and Non-MISMI Groups

	ALL N=70	Non-MSIMI N=39	MSIMI N=31	P
Age (years)	53.46±8.5	52.64±8.27	54.48±8.81	0.371
Height (cm)	159.21±4.92	158.49±4.93	160.13±4.84	0.167
Body mass (kg)	59.93±8.69	57.62±8.27	62.83±8.45	0.012
BMI (kg/m^2)	23.6±2.89	22.91±2.85	24.46±2.76	0.026
CCS scale I	50(71.43)	30(76.92)	20(64.52)	0.254
II	20(28.57)	9(23.08)	11(35.48)
Hypertension (%)	16(22.86)	7(17.95)	9(29.03)	0.273
Hyperlipidemia (%)	20(28.57)	12(30.77)	8(25.81)	0.648
Diabetes (%)	5(7.14)	2(5.13)	3(9.68)	0.649
Arrhythmia (%)	8(11.43)	4(10.26)	4(12.9)	0.73
Total cholesterol (mmol/L)	5.02±1.09	5.20±1.00	4.79±1.18	0.117
Triglycerides (mmol/L)	1.49±0.86	1.4±0.79	1.6±0.95	0.353
LDL-C (mmol/L)	3.15±0.81	3.28±0.73	2.99±0.89	0.145
OSA (%)	34(48.57)	13(33.33)	21(67.74)	0.004

Abbreviations: MSIMI, mental stress induce myocardial ischemia; BMI, body mass index; CCS scale, Canada cardiovascular society grading scale for angina; LDL-C, low-density lipoprotein cholesterol; OSA, obstructive sleep apnea.

Figure 1 The proportion of individuals with OSA in both cohorts. In the MSIMI group, there is a higher proportion of patients with OSA (P = 0.004), with a greater percentage being classified as mild to moderate (P = 0.016).

Abbreviations: MSIMI, mental stress induce myocardial ischemia; OSA, obstructive sleep apnea.

Table 2 The Distinction in Sleep Monitoring Between the MSIMI and Non-MSIMI Cohorts

	All N=70	MSIMI- N=39	MSIMI+ N=31	P
Apnea	7.5(2/27.25)	6(2/21)	13(2/32)	0.452
Duration (min)	2.1(0.475/9.35)	1.3(0.5/9.3)	3.8(0.4/9.5)	0.492
AI (h^−1)	1.1(0.2/3.175)	0.7(0.2/2.9)	1.4(0.2/3.5)	0.47
Hypopnea	24.5(7.75/55.5)	12(5/41)	39(20/70)	0.006
Duration (min)	11.85(3.225/23.6)	5.8(1.8/21)	14.5(8/25.8)	0.063
HI (h^−1)	3.3(0.9/6.45)	1.5(0.6/4.9)	4.5(2/9.1)	0.005
AH	35.5(11/82)	20(9/76)	61(27/99)	0.024
Duration (min)	14.1(4.325/34.025)	8.8(2.8/33.9)	22.9(11.3/34.4)	0.093
REI (h^−1)	4.7(1.525/9.825)	2.6(1.1/9)	7.8(3.1/13)	0.019
OD	50(19.75/99.75)	36(12/86)	72(25/120)	0.024
ODI (h^−1)	6.25(2.48/12.65)	4.7(1.7/9.8)	9.7(3.7/15.9)	0.028

Abbreviations: MSIMI, mental stress induced myocardial ischemia; AI, apnea index; HI, hypopnea index; AH, apnea and hypopnea; REI, respiratory event index; OD, oxygen desaturation; ODI, oxygen desaturation index.

Table 3 Logistic Regression Analysis of MSIMI Predictive Factors

	Model 1			Model 2			Model 3
	β	P	OR (95% CI)	β	P	OR (95% CI)	β	P	OR (95% CI)
OSA	1.435	0.005	4.2(1.537–11.476)	1.236	0.02	3.443(1.215–9.756)	1.226	0.021	3.408(1.200–9.681)
BMI	—	—	—	0.146	0.132	1.157(0.957–1.399)	0.143	0.145	1.153(0.952–1.397)
CVD risk factor	—	—	—	—	—	—	0.293	0.576	1.341(0.480–3.745)

Notes: CVD risk factor including smoking, chronic diseases like hypertension, hyperlipidemia, and diabetes.

Abbreviations: MSIMI: mental stress induced myocardial ischemia; OSA: obstructive sleep apnea; BMI: body mass index; CVD: Cardiovascular Disease.

Table 4 Characteristics of Patients in OSA and Non-OSA Groups

	ALL N=70	Non-OSA N=36	OSA N=34	P
Age (years)	53.46±8.5	49.39±7.83	57.76±6.99	<0.001
Height (cm)	159.21±4.92	158.92±5.13	159.53±4.74	0.606
Body mass (kg)	59.93±8.69	57.53±7.37	62.46±9.35	0.017
BMI (kg/m^2)	23.6±2.89	22.77±2.56	24.47±3	0.013
CCS scale I	50(71.43)	27(75)	23(67.65)	0.496
II	20(28.57)	9(25)	11(32.35)
Hypertension (%)	16(22.86)	7(19.44)	9(26.47)	0.484
Hyperlipidemia (%)	20(28.57)	10(27.78)	10(29.41)	0.88
Diabetes (%)	5(7.14)	2(5.56)	3(8.82)	0.596
Arrhythmia (%)	8(11.43)	5(13.89)	3(8.82)	0506
Hb (g/L)	127.88±9.37	125.46±7.91	130.38±10.19	0.028
ALT (U/L)	18.43±9.65	16.08±7.58	20.91±11.03	0.036
AST (U/L)	19.87±8.29	17.39±3.44	22.5±10.83	0.009
ADA (U/L)	7.98±2.06	7.32±1.64	8.68±2.24	0.005
TBIL (μmol/L)	11.56±3.62	10.03±2.81	13.14±3.71	<0.001
DBIL (μmol/L)	2.26±0.69	1.99±0.46	2.52±0.77	0.002
PS (%)	78.49±17.1	84.34±16.75	72.47±15.49	0.003

Abbreviations: OSA, obstructive sleep apnea; BMI, body mass index; CCS scale, Canada cardiovascular society grading scale for angina; Hb, hemoglobin; ALT, alanine transaminase; AST, aspartate transaminase; ADA, adenosine deaminase; TBIL, total bilirubin; DBIL, direct bilirubin; PS, plasma protein S.

Figure 2 Myocardial Perfusion in OSA and Non-OSA patients. (A) There was no discernible variation in myocardial perfusion levels between the two cohorts of patients in a state of rest (SRS). Nevertheless, a noteworthy dissimilarity in myocardial perfusion levels was observed subsequent to mental stress (SSS), and the variance in the degree of alteration before and after was statistically significant (SDS). (B) The myocardial perfusion summed score in the OSA group showed a significant improvement after mental stress.

Abbreviations: OSA, obstructive sleep apnea; SRS, summed rest score; SSS, summed stress score; SDS, summed difference score.

Data Sharing Statement

All data will be shared upon reasonable request to the corresponding authors.