Excessive daytime sleepiness is associated with longer culprit lesion and adverse outcomes in patients with coronary artery disease

• Published in: Journal of clinical sleep medicine Vol. 9; no. 12; pp. 1267 - 1272
• Main Authors: Lee, Chi-Hang, Ng, Wai-Yee, Hau, William, Ho, Hee-Hwa, Tai, Bee-Choo, Chan, Mark Y, Richards, A Mark, Tan, Huay-Cheem
• Format: Journal Article
• Language: English
• Published: United States American Academy of Sleep Medicine 15.12.2013
• Subjects: Cholesterol - blood; Cohort Studies; Coronary Angiography - methods; Coronary Artery Disease - blood; Coronary Artery Disease - complications; Coronary Artery Disease - diagnostic imaging; Coronary Stenosis - blood; Coronary Stenosis - complications; Disorders of Excessive Somnolence - blood; Disorders of Excessive Somnolence - complications; Female; Follow-Up Studies; Heart Failure - blood; Heart Failure - complications; Humans; Male; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - complications; New Research; Patient Outcome Assessment; Plaque, Atherosclerotic - blood; Plaque, Atherosclerotic - complications; Plaque, Atherosclerotic - diagnostic imaging; Prospective Studies; Risk Assessment - methods; Risk Factors; Severity of Illness Index; Singapore; Surveys and Questionnaires; Ultrasonography, Interventional - methods; coronary artery disease; intravascular ultrasound; outcomes; Sleepiness
• ISSN: 1550-9389; 1550-9397
• DOI: 10.5664/jcsm.3266

We assessed whether excessive daytime sleepiness was associated with coronary plaque phenotype and subsequent adverse cardiovascular events. Prospective cohort study. Intravascular ultrasound (IVUS) examination of the culprit coronary stenosis was performed. The Epworth Sleepiness Scale (ESS) questionnaire was administered, and the patients were divided into 2 groups-(1) sleepier and (2) less sleepy-based on the ESS score. Adverse cardiovascular outcomes were defined as cardiac death, myocardial infarction, stroke, unplanned revascularization, or heart failure admission. One hundred seventeen patients undergoing urgent or non-urgent coronary angiography were recruited. Compared with the less sleepy group (ESS ≤ 10, n = 87), the sleepier group (ESS > 10, n = 30) had higher serum levels of total cholesterol and of low-density-lipoprotein cholesterols (p < 0.05 for both). The IVUS examinations indicated coronary stenoses were longer in the sleepier group than in the less sleepy group (p = 0.011). The cumulative incidence of adverse cardiovascular events at 16-month follow-up was higher in the sleepier than the less sleepy group (12.5% versus 6.9%, p = 0.03). Cox regression analysis adjusting for age and smoking showed increased hazard of adverse cardiovascular events in sleepier group as compared to less sleepy group (HR = 3.44, 95% CI 1.01-11.72). In patients presenting with coronary artery disease, excessive daytime sleepiness based on ESS > 10 was associated with longer culprit lesions and future adverse cardiovascular events.