Diabetes Mellitus Helps Predict Obstructive Sleep Apnea During REM Sleep

Aye Thida Aung, MBBS, MRCP

Following a percutaneous coronary intervention, diabetes mellitus can be an independent predictor of obstructive sleep apnea (OSA) during rapid eye movement (REM) sleep.

According to data planned for presentation at the American Thoracic Society (ATS) 2020 International Conference, a team, led by Aye Thida Aung, MBBS, MRCP, Department of Cardiology, National University Heart Center, characterized obstructive sleep apnea during rapid eye movement of sleep in patients following recent percutaneous coronary intervention.

Obstructive sleep apnea during the rapid eye movement stage of the sleep cycle is linked to intense hypoxemic insult and cardiovascular instability.

In the study, the investigators examined 204 patients from 3 tertiary hospitals in Singapore who had undergone percutaneous coronary intervention in the 6-36 months prior to beginning the trial. The mean age of the trial was 57.9 ± 7.8 and 88% of the participants were male.

The investigators sought a primary measure of REM apnea-hypopnea index (AHI), calculated as the number of apnea and hypopnea per hour of REM sleep.

Each patient was dived into either a OSA during REM sleep (REM AHI ≥15 events/hour) group or an absence of OSA during REM sleep (REM AHI <15) group.

The investigators excluded patients who failed polysomnography or REM sleep <30 minutes, which precludes precise REM AHI measurements. They included 163 patients for the final analysis.

The indication for percutaneous coronary intervention was acute coronary syndrome in 113 (69.3%) patients, while OSA during REM sleep was diagnosed in 132 patients (81%).

Patients with obstructive sleep apnea during REM sleep had higher body mass indexes (P = 0.003), systolic blood pressure (P = 0.041), and prevalence of diabetes mellitus (P = 0.029).

On the other hand, patients with obstructive sleep apnea during REM sleep experienced lower oxygen saturation and longer time with oxygen saturation < 90% (P <0.001 for all).

The investigators did not find significant differences in angiographic and coronary intervention characteristics, medication upon discharge, left ventricular dimension and ejection fraction between the 2 groups.

However, patients with obstructive sleep apnea had significantly lower E/A ratio (1.0±0.4 vs 1.3±0.6; P = 0.004).

After adjusting for age, sex, diabetes mellitus , indication for percutaneous coronary intervention, and multi-vessel percutaneous coronary intervention, the investigators found diabetes mellitus was the only independent predictor of OSA during REM sleep (OR, 2.83; 95% CI, 1.17-6.83; P = 0.021).

For the 132 patients with OSA during REM sleep, the AHI was <15 events per hour in 21 patients (15.9%), but none of the patients had AHI <5 events per hour. This suggests that patients with obstructive sleep apnea would have been missed using conventional diagnostic criteria.

“In patients treated with percutaneous coronary intervention, there was a high prevalence of OSA during REM sleep,” the authors wrote. “Diabetes mellitus was an independent predictor of OSA during REM sleep.”

The study, “Obstructive Sleep Apnea During Rapid Eye Movement Sleep in Patients After Percutaneous Coronary Intervention: A Multicenter Study,” was published online by the ATS International Conference.