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Obstructive sleep apnoea is associated with myocardial injury in patients with refractory angina
  1. Glaucylara R Geovanini1,
  2. Alexandre C Pereira2,
  3. Luis H W Gowdak3,
  4. Luciana Oliveira Cascaes Dourado3,
  5. Nilson T Poppi3,
  6. Gabriela Venturini2,
  7. Luciano F Drager1,4,
  8. Geraldo Lorenzi-Filho1
  1. 1Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), University of São Paulo (USP), Sao Paulo, Brazil
  2. 2Laboratory of Genetics and Molecular Cardiology, InCor, USP, Sao Paulo, Brazil
  3. 3Refractory Angina Research Group, InCor, USP, Sao Paulo, Brazil
  4. 4Hypertension Unit, InCor, USP, Sao Paulo, Brazil
  1. Correspondence to Dr Geraldo Lorenzi-Filho, Director of Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), University of São Paulo, Medical School, Av Dr Enéas Carvalho de Aguiar, 44—Laboratório do Sono, São Paulo 05403-000, Brazil; geraldo.lorenzi{at}


Objective To investigate the association between obstructive sleep apnoea (OSA) severity with markers of overnight myocardial injury in patients with refractory angina.

Methods Patients with refractory angina were characterised clinically and they underwent ischaemia imaging stress tests by single-photon emission computed tomography (SPECT) and/or cardiac MRI. The patients were admitted to the hospital, remained under resting conditions for blood determination of high-sensitivity cardiac troponin T (hs-cTnT) at 14:00, 22:00 and after overnight polysomnography at 7:00.

Results We studied 80 consecutive patients (age: 62±10 years; male: 66%; body mass index (BMI): 29.5±4 kg/m2) with well-established diagnosis of refractory angina. The mean apnoea–hypopnoea index (AHI) was 37±29 events/h and OSA (AHI >15 events/h) was present in 75% of the population. Morning detectable hs-cTnT and above 99th percentile was present in 88% and 36% of the population, respectively. Patients in the first to third quartiles of OSA severity did not have circadian variation of hs-cTnT. In contrast, patients in the fourth quartile (AHI ≥51 events/h) had a circadian variation of hs-cTnT with a morning peak of hs-cTnT that was two times higher than that in the remaining population (p=0.02). The highest quartile of OSA severity remained associated with the highest quartile of hs-cTnT (p=0.028) in multivariate analysis.

Conclusion Very severe OSA is common and independently associated with overnight myocardial injury in patients with refractory angina.

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