Central sleep apnea after acute coronary syndrome and association with ticagrelor use

• Published in: Sleep medicine Vol. 80; pp. 39 - 45
• Main Authors: Meurin, Ph, Ben Driss, A., Defrance, C., Dumaine, R., Weber, H., Renaud, N., Bonnevie, L., Mouram, S., Tabet, J.Y.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.04.2021
• Subjects: Acute coronary syndrome; Acute Coronary Syndrome - complications; Acute Coronary Syndrome - drug therapy; Aged; Antiplatelet drug; Central sleep apnea; Cheyne-Stokes respiration; Female; Humans; Male; Middle Aged; Sleep Apnea, Central - chemically induced; Stroke Volume; Ticagrelor; Ticagrelor - adverse effects; Ventricular Function, Left; Cheyne-Stokes respiration; Central sleep apnea; Ticagrelor; Acute coronary syndrome; Antiplatelet drug
• ISSN: 1389-9457; 1878-5506
• DOI: 10.1016/j.sleep.2021.01.026

By modifying the apneic threshold, the antiplatelet agent ticagrelor could promote central sleep apnea hypopnea syndrome (CSAHS). We aimed to assess the association between CSAHS and ticagrelor administration. Patients were prospectively included within 1 year after acute coronary syndrome (ACS), if they had no heart failure (and left ventricular ejection fraction ≥ 45%) and no history of sleep apnea. After an overnight sleep study, patients were classified as “normal” with apnea hypopnea index (AHI) < 15, “CSAHS patients” with AHI ≥ 15 mostly with central sleep apneas, and “obstructive sleep apnea hypopnea syndrome (OSAHS) patients” with AHI ≥ 15 mostly with obstructive sleep apneas. We included 121 consecutive patients (mean age 56.8 ± 10.8, 88% men, mean body mass index 28.3 ± 4.4 kg/m2, left ventricular ejection fraction 56 ± 5%, at a mean of 67 ± 60 days (median 40 days, interquartile range: 30–80 days) after ACS. In total, 49 (45.3%) patients had AHI ≥ 15 (27 [22.3%] CSAHS %, 22 [18.2%] OSAHS). For 80 patients receiving ticagrelor, 24 (30%) had CSAHS with AHI ≥ 15, and for 41 patients not taking ticagrelor, only 3 (7.3%) had CSAHS with AHI ≥ 15 (chi-square = 8, p = 0.004). On multivariable analysis only age and ticagrelor administration were associated with the occurrence of CSAHS, (p = 0.0007 and p = 0.0006). CSA prevalence after ACS is high and seems promoted by ticagrelor administration. Results from monocentric study suggest a preliminary signal of safety. NCT03540459. •Dyspnea often occurs in patients with acute coronary syndrome treated with ticagrelor.•This probably results from a direct effect on the central nervous system that increases chemosensitivity to hypercapnia.•A few clinical cases of patients with central sleep apnea who received this drug have been published.•We confirm that central sleep apnea is frequent in patients receiving ticagrelor, even for those without Heart Failure.