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Volume 09 No. 12
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Scientific Investigations

Excessive Daytime Sleepiness is Associated with Longer Culprit Lesion and Adverse Outcomes in Patients with Coronary Artery Disease

http://dx.doi.org/10.5664/jcsm.3266

Chi-Hang Lee, M.D.1,2; Wai-Yee Ng, B.Sc.3; William Hau, Ph.D.2; Hee-Hwa Ho, MB.BS.4; Bee-Choo Tai, Ph.D.2,3; Mark Y. Chan, MB.BS.1,2; A. Mark Richards, M.D., Ph.D.1,2; Huay-Cheem Tan, MB.BS.1
1Department of Cardiology, National University Heart Centre, Singapore; 2Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; 3Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore; 4Department of Cardiology, Tan Tock Seng Hospital, Singapore

Study Objectives:

We assessed whether excessive daytime sleepiness was associated with coronary plaque phenotype and subsequent adverse cardiovascular events.

Methods:

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.

Results:

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).

Conclusion:

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.

Citation:

Lee CH; Ng WY; Hau W; Ho HH; Tai BC; Chan MY; Richards AM; Tan HC. Excessive daytime sleepiness is associated with longer culprit lesion and adverse outcomes in patients with coronary artery disease. J Clin Sleep Med 2013;9(12):1267-1272.




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