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Eur Respir J. 2014 Jun;43(6):1652-60. doi: 10.1183/09031936.00130913. Epub 2014 Feb 20.

Sleep apnoea is associated with major cardiac events in peripheral arterial disease.

Author information

  • 1Division of Medicine, Turku University Hospital, Turku Sleep Research Unit, University of Turku, Turku.
  • 2Heart Centre, Turku University Hospital and University of Turku, Turku.
  • 3Sleep Research Unit, University of Turku, Turku Dept of Pulmonology, Tampere University Hospital, Tampere.
  • 4Division of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku.
  • 5Dept of Biostatistics, University of Turku, Turku.
  • 6Dept of Vascular Surgery, Turku University Hospital, Turku.
  • 7Dept of Radiology, Turku University Hospital, Turku, Finland.
  • 8Division of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku


Obstructive sleep apnoea (OSA) is associated with atherosclerosis and cardiovascular events. Peripheral arterial disease (PAD) represents severe atherosclerosis with a high mortality after vascular surgery. The role of OSA in the prognosis of these patients is not yet established. 84 patients (aged 67 ± 9 years) scheduled for sub-inguinal surgical revascularisation were enrolled for preoperative polysomnography. The threshold for significant OSA was an apnoea/hypopnoea index ≥ 20 events·h(-1). Major adverse cardiovascular and cerebrovascular events (MACCE), including cardiac death, myocardial infarction, coronary revascularisation, angina pectoris requiring hospitalisation and stroke, were used as a combined end-point. During follow-up (median 52 months), 17 out of 39 patients with and six out of 45 patients without significant OSA suffered MACCE. In the multivariate Cox regression, the primary predictors of MACCE were significant OSA (hazard ratio (HR) 5.1 (95% CI 1.9-13.9); p=0.001) and pre-existing coronary artery disease (HR 4.4 (95% CI 1.8-10.6); p=0.001). Other significant predictors were a ≥ 4 year history of PAD (HR 3.8 (95% CI 1.3-11.5); p=0.02) and decreasing high-density lipoprotein/total cholesterol ratio (HR 0.95 per percentage (95% CI 0.90-1.00); p=0.048). OSA is associated with poor long-term outcome in patients with PAD following revascularisation. OSA might have an important role in the pathogenesis of cardiovascular morbidity and mortality in these patients.

©ERS 2014.

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