Obstructive sleep apnea affects the clinical outcomes of patients undergoing percutaneous coronary intervention

Figures & data

Figure 1 Flowchart of study design.

Abbreviations: CPAP, continuous positive airway pressure; DES, drug-eluting stent; IABP, intra-aortic balloon pump; OSA, obstructive sleep apnea; SBP, systolic blood pressure.

Table 1 Baseline clinical and sleep characteristics of the OSA and non-OSA groups

Characteristics	OSA (n=152)	Non-OSA (n=188)	P-value
Age, years	65.6±10.3	64.0±10.4	0.170
Males, n (%)	120 (78.9)	129 (68.6)	0.032
BMI, kg/m^2	25.4±2.9	24.5±3.1	0.007
Hypertension, n (%)	113 (74.3)	132 (70.2)	0.399
Hyperlipidemia, n (%)	107 (70.9)	124 (66.0)	0.336
Diabetes, n (%)	50 (32.9)	45 (23.9)	0.067
Stroke, n (%)	15 (9.9)	25 (13.3)	0.329
Smoking status, n (%)			0.083
Current smoker	49 (32.2)	70 (37.2)
Former smoker	18 (11.8)	10 (5.3)
eGFR, mL/min/1.73 m^2	105.7±28.8	126.0±30.2	0.358
Previous MI, n (%)	23 (15.1)	18 (9.6)	0.118
Stable angina, n (%)	17 (11.2)	17 (9.0)	0.513
Unstable angina, n (%)	105 (69.1)	130 (69.1)	0.989
STEMI, n (%)	10 (6.6)	20 (10.6)	0.189
NSTEMI, n (%)	11 (7.2)	10 (5.3)	0.465
CHF, n (%)	24 (15.8)	21 (11.2)	0.211
LVEF, %	59.2±10.6	61.5±8.2	0.067
LVDd, mm	50.6±6.8	48.2±4.6	0.003
Previous PCI, n (%)	33 (21.7)	32 (17.0)	0.274
Previous CABG, n (%)	2 (1.3)	2 (1.1)	0.830
PAD, n (%)	4 (2.7)	2 (1.2)	0.319
Sleep study characteristics
AHI	30.9 (21.8, 43.5)	8.4 (3.9, 11.9)	<0.001
Average SpO2, %	93.3 (92.1, 94.3)	93.9 (92.8, 94.8)	0.001
Lowest SpO2, %	82.0 (79.0, 85.0)	87.0 (82.0, 88.0)	<0.001
Time SpO2 <90%, minutes	16.3 (5.7, 47.2)	5.1 (0.8, 26.9)	<0.001
Time SpO2 <80%, minutes	0.4 (0.1, 1.4)	0.2 (0.0, 0.4)	0.041

Note: Continuous variables were summarized as mean ± standard deviation for normal data or median (quartile) for non-normally distributed variables.

Abbreviations: AHI, apnea–hypopnea index; BMI, body mass index; CABG, coronary artery bypass grafting; CHF, congestive heart failure; eGFR, estimated glomerular filtration rate; LVEF, left ventricular ejection fraction; LVDd, left ventricular end diastolic diameter; MI, myocardial infarction; NSTEMI, non-STEMI; OSA, obstructive sleep apnea; PAD, peripheral artery disease; PCI, percutaneous coronary intervention; ST, stent thrombosis; STEMI, ST-segment elevation MI.

Table 2 Angiographic and procedural characteristics of the OSA and non-OSA groups

Characteristics	OSA (n=152)	Non-OSA (n=188)	P-value
Angiographic characteristics
Number of diseased vessels			0.017
One-vessel disease	47 (30.9)	84 (44.7)	0.010
Two-vessel disease	52 (34.2)	60 (31.9)	0.654
Three-vessel disease	53 (34.9)	44 (23.4)	0.020
CTO lesion			0.507
LAD	11 (7.2)	7 (3.7)
LCX	5 (3.3)	6 (3.2)
RCA	12 (7.9)	10 (5.3)
>1 CTO	1 (0.7)	2 (1.1)
Needing rotablation	2 (1.3)	1 (0.5)	0.442
Thrombus-containing lesions	7 (4.7)	7 (3.7)	0.673
Procedural characteristics
Transradial, n (%)	148 (97.4)	184 (97.9)	0.549
IIb/IIIa inhibitor used, n (%)	18 (12.1)	18 (10.7)	0.688
IVUS assessment, n (%)	31 (20.8)	29 (17.2)	0.407
FFR assessment, n (%)	24 (16.1)	37 (21.9)	0.191
OCT assessment, n (%)	9 (6.0)	8 (4.7)	0.605
DES used, n (%)	152 (100)	188 (100)	NS
Total implanted stents	3.3±2.0	2.8±1.9	0.007
Mean stent diameter, mm	3.0±0.4	3.0±0.4	0.279
Total stent length, mm	83.8±53.1	68.7±48.4	0.010
Complete revascularization, n (%)	96 (63.2)	132 (70.2)	0.169
Final TIMI grade 3, n (%)	150 (98.7)	187 (99.5)	0.193
Procedural time, minutes	64.0±49.7	52.8±39.6	0.026
Contrast volume, mL	211.0±108.1	190.2±89.3	0.053

Notes: Continuous variables were summarized as mean ± standard deviation for normal data or median (quartile) for non-normally distributed variables. Categorical variables were expressed as percentages.

Abbreviations: CTO, chronic total occlusion; DES, drug-eluting stent; FFR, fractional flow reserve; IVUS, intravascular ultrasound; LAD, left anterior descending artery; LCX, left circumflex artery; MI, myocardial infarction; NS, nonsignificant; OCT, optical coherence tomography; OSA, obstructive sleep apnea; RCA, right coronary artery; TIMI, thrombolysis in MI.

Figure 2 MACE-free survival rate at 2 years.

Note: Freedom from MACEs between the OSA group (red line) and non-OSA group (blue line) at 2-year follow-up.
Abbreviations: MACEs, major adverse cardiac events; OSA, obstructive sleep apnea.

Table 3 Clinical outcomes in the OSA and non-OSA groups

Outcomes	OSA (n=152)	Non-OSA (n=188)	P-value
In-hospital, n (%)
Cardiac death	0	0	NS
Periprocedural MI	29 (19.2)	21 (11.2)	0.038
Spontaneous MI	0	0	NS
TLR	0	0	NS
CABG	0	0	NS
TVR	0	0	NS
MACEs	0	0	NS
ST	0	0	NS
At 1 year, n (%)
Cardiac death	1 (0.7)	1 (0.5)	0.880
Periprocedural MI	29 (19.2)	21 (11.2)	0.038
Spontaneous MI
STEMI	0	0	NS
NSTEMI	2 (1.3)	1 (0.5)	0.442
TLR	5 (3.3)	5 (2.7)	0.773
CABG	1 (0.7)	0	0.265
TVR	7 (4.6)	5 (2.7)	0.334
MACEs	37 (24.3)	27 (14.4)	0.019
ST	2 (1.3)	2 (1.1)	0.830
At 2 years, n (%)
Cardiac death	3 (2.0)	1 (0.5)	0.220
Periprocedural MI	29 (19.2)	21 (11.2)	0.038
Spontaneous MI
STEMI	0	0	NS
NSTEMI	2 (1.3)	1 (0.5)	0.442
TLR	6 (3.9)	8 (4.3)	0.887
CABG	1 (0.7)	0	0.265
TVR	8 (5.3)	9 (4.8)	0.841
MACEs	38 (25.0)	30 (16.0)	0.038
ST	3 (2.0)	2 (1.1)	0.660

Abbreviations: CABG, coronary artery bypass grafting; MACEs, major adverse cardiac events; MI, myocardial infarction; NS, nonsignificant; NSTEMI, non-ST segment elevation MI; OSA, obstructive sleep apnea; ST, stent thrombosis; STEMI, ST segment elevation MI; TLR, target lesion revascularization; TVR, target vessel revascularization.

Table 4 Univariate and multivariate analyses for MACEs

Variables	Univariate analysis; HR (95% CI)	P-value	Multivariate analysis; HR (95% CI)	P-value
Age	0.999 (0.976, 1.022)	0.916
Male	1.235 (0.705, 2.163)	0.461
BMI	1.051 (0.980, 1.126)	0.163
Hypertension	0.940 (0.558, 1.584)	0.817
Current smoker	1.244 (0.765, 2.022)	0.379
Diabetes mellitus	0.845 (0.488, 1.463)	0.548
Ejection fraction	0.976 (0.952, 1.002)	0.069	0.985 (0.955, 1.015)	0.315
hsCRP	0.998 (0.971, 1.026)	0.875
OSA	1.627 (1.007, 2.628)	0.047	1.962 (1.036, 3.717)	0.039
Total implanted stents	1.069 (0.953, 1.199)	0.253
Multivessel disease	1.453 (0.869, 2.432)	0.155

Note: Multivariate analysis data is not shown for several variables because these variables did not enter the multivariate model for their nonsignificant results in the univariate analysis.

Abbreviations: BMI, body mass index; CI, confidence interval; HR, hazard ratio; hsCRP, high-sensitivity C-reactive protein; MACEs, major adverse cardiac events; OSA, obstructive sleep apnea.

Table 5 Quantitative coronary analysis of the OSA and non-OSA groups

Variables	OSA (231 lesions)	Non-OSA (277 lesions)	P-value
Lesion length, mm	35.22±19.18	31.82±19.45	0.048
Preprocedure
Reference diameter, mm	2.83±0.46	2.85±0.49	0.621
Minimal lumen diameter, mm	1.03±0.56	1.05±0.61	0.647
Diameter stenosis, %	64.21±18.87	63.46±20.29	0.669
Postprocedure
Reference diameter, mm	2.96±0.45	2.96±0.46	0.961
Minimal lumen diameter, mm	2.59±0.46	2.56±0.51	0.453
Diameter stenosis, %	12.71±6.21	13.74±9.69	0.165
Acute gain, mm	1.56±0.56	1.51±0.61	0.283
At follow-up
Reference diameter, mm	2.95±0.43	2.97±0.46	0.700
Minimal lumen diameter, mm	2.41±0.61	2.40±0.61	0.796
Diameter stenosis, %	18.83±14.79	19.86±13.95	0.492
Late loss, mm	0.19±0.40	0.21±0.33	0.604
Net gain, mm	1.37±0.66	1.33±0.67	0.523
Restenosis, %	12 (6.6)	7 (3.5)	0.165

Notes: Continuous variables were summarized as mean ± standard deviation for normal data or median (quartile) for non-normally distributed variables. Categorical variables were expressed as percentages.

Abbreviation: OSA, obstructive sleep apnea.

Figure 3 Forest plots of 2-year MACE rate in the prespecified subgroups.

Note: Data in the Events columns presented as number of events/total number of patients.
Abbreviations: ACS, acute coronary syndrome; BMI, body mass index; CAD, coronary artery disease; CI, confidence interval; MACEs, major adverse cardiac events; OR, odds ratio; OSA, obstructive sleep apnea.