Sleep apnea and heart
Ischemic heart disease, and may be associated with increased morbidity and mortality due to
cardiovascular disease. The aim of this study was to examine the relation between nocturnal
oxygen desaturation (NOD) due to SDB and the Gensini score, which is given to define the
severity of coronary atherosclerosis, based on coronary angiograms findings, in patients with
coronary artery disease.
Design: We examined the NOD index (ODI) (desaturation of > 3%/events per hour) using pulse
oximetry in 59 consecutive patients with coronary artery disease (ejection fraction, > 40%) that
was diagnosed by coronary angiography, 30 patients with angina pectoris and 29 patients with old
myocardial infarction. The Gensini score was calculated for each patient from the coronary
arteriogram. The patients were classified into the following three groups according to the
severity of oxygen desaturation: ODI of < 5 events per hour (group N; 16 patients); ODI of  5
but < 15 events per hour (group A; 27 patients); and ODI of  15 events per hour (group B; 16
patients). The groups then were examined for the relation between the ODI and the Gensini
Results: Of the total number of patients, 72.9% had a nocturnal ODI of more than five events per
hour. The Gensini score was significantly higher in groups A and B than in group N, and showed
a significant positive correlation with the ODI (R  0.45; p  0.01) in all patients. Multiple
regression analysis showed that the ODI was the most significant, independent determinant of
the Gensini score among the coronary risk factors tested, and that it explained 13.4% of the
Conclusion: These findings suggest that NOD due to SDB may be an important contributor to
coronary atherosclerosis in the patients with cardiovascular disease.

(CHEST 2003; 124:936–941)

C-reactive protein (CRP) predicts atherosclerotic complications.
Conclusions: In healthy middle-aged men, elevated CRP level is associated with OSA independent
of visceral obesity. (CHEST 2009; 135:950–956)

Association of Atrial Fibrillation and Obstructive Sleep Apnea

Apoor S. Gami, MD; Gregg Pressman, MD; Sean M. Caples, MD; Ravi Kanagala, MD;
Joseph J. Gard, BS; Diane E. Davison, RN, MA; Joseph F. Malouf, MD; Naser M. Ammash, MD;
Paul A. Friedman, MD; Virend K. Somers, MD, PhD
Background—Obstructive sleep apnea (OSA) is associated with recurrent atrial fibrillation (AF) after electrocardioversion.
OSA is highly prevalent in patients who are male, obese, and/or hypertensive, but its prevalence in patients with AF isunknown.
Methods and Results—We prospectively studied consecutive patients undergoing electrocardioversion for AF (n151)and consecutive patients without past or current AF referred to a general cardiology practice (n312). OSA wasdiagnosed with the Berlin questionnaire, which is validated to identify patients with OSA. We also assessed its accuracy compared with polysomnography in a sample of the study population. Groups were compared with the 2-tailed Wilcoxon, and 2 tests. Logistic regression modeled the association of AF and OSA after adjustment for relevant
covariates. Patients in each group had similar age, gender, body mass index, and rates of diabetes, hypertension, andcongestive heart failure. The questionnaire performed with 0.86 sensitivity, 0.89 specificity, and 0.97 positive predictive value in our sample. The proportion of patients with OSA was significantly higher in the AF group than in the general cardiology group (49% versus 32%, P0.0004). The adjusted odds ratio for the association between AF and OSA was 2.19 (95% CI 1.40 to 3.42, P0.0006).
Conclusions—The novel finding of this study is that a strong association exists between OSA and AF, such that OSA isstrikingly more prevalent in patients with AF than in high-risk patients with multiple other cardiovascular diseases. Thecoinciding epidemics of obesity and AF underscore the clinical importance of these results. (Circulation. 2004;110:364-367
Stroke and Sleep Specialists: An Opportunity to Intervene?
Commentary on Johnson KG, Johnson DC. Frequency of Sleep Apnea in Stroke and
TIA Patients: A Meta-analysis. J Clin Sleep Med 2010;6:131-137.
Nathaniel F. Watson, M.D., M.S.
University of Washington (UW), Department of Neurology and UW Medicine Sleep Institute, Seattle, WA
Obstructive Sleep Apnea, Insulin Resistance, and Steatohepatitis in Severe Obesity
Conclusions: Hypoxic stress of sleep apnea may be implicated in the development of insulin resistance and steatohepatitis in severe obesity.
Am J Respir Crit Care Med Vol 179. pp 228–234, 2009
Perioperative Management of Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) is the most common breathing disorder, with a high prevalence
in both the general and surgical populations. OSA is frequently undiagnosed, and the initial
recognition often occurs during medical evaluation undertaken to prepare for surgery. Adverse
respiratory and cardiovascular outcomes are associated with OSA in the perioperative period;
therefore, it is imperative to identify and treat patients at high risk for the disease. In this review,
we discuss the epidemiology of OSA in the surgical population and examine the available data
on perioperative outcomes. We also review the identifi cation of high-risk patients using clinical
screening tools and suggest intraoperative and postoperative treatment regimens. Additionally,
the role of continuous positive airway pressure in perioperative management of OSA and a brief
discussion of ambulatory surgery in patients with OSA is provided. Finally, an algorithm to guide
perioperative management is suggested. CHEST 2010; 138( 6 ): 1489 – 1498