High risk for obstructive sleep apnea in patients with acute myocardial infarction

Andrechuk, Carla Renata Silva; Ceolim, Maria Filomena

doi:10.1590/0104-1169.0511.2617

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Revista Latino-Americana de Enfermagem

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Original Articles • Rev. Latino-Am. Enfermagem 23 (5) • Sep-Oct 2015 • https://doi.org/10.1590/0104-1169.0511.2617 copy

High risk for obstructive sleep apnea in patients with acute myocardial infarction¹ 1 Paper extracted from master's thesis "Sleep, daytime sleepiness and risk for obstructive sleep apnea in patients with acute myocardial infarction", presented to Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objectives:

to stratify the risk for obstructive sleep apnea in patients with acute myocardial infarction, treated at a public, tertiary, teaching hospital of the state of São Paulo, Brazil, and to identify related sociodemographic and clinical factors.

Method:

cross-sectional analytical study with 113 patients (mean age 59.57 years, 70.8% male). A specific questionnaire was used for the sociodemographic and clinical characterization and the Berlin Questionnaire for the stratification of the risk of obstructive sleep apnea syndrome.

Results:

the prevalence of high risk was 60.2% and the outcome of clinical worsening during hospitalization was more frequent among these patients. The factors related to high risk were body mass index over 30 kg/m2, arterial hypertension and waist circumference indicative of cardiovascular risk, while older age (60 years and over) constituted a protective factor.

Conclusion:

considering the high prevalence of obstructive sleep apnea and its relation to clinical worsening, it is suggested that nurses should monitor, in their clinical practice, people at high risk for this syndrome, guiding control measures of modifiable factors and aiming to prevent the associated complications, including worsening of cardiovascular diseases.

Sleep; Myocardial Infarction; Sleep Apnea Syndromes; Nursing

Sociodemographic and clinical variables*	Stratification of risk for OSAS ^†	Total
	Low	High
	n (45)	%	n (68)	%	n (113)	%
Gender
	Male	33	41.2	47	58.8	80	100.0
	Female	12	36.4	21	63.6	33	100.0
Age group
	Less than 60 years	19	33.3	38	66.7	57	100.0	100.0
	60 years or over	26	46.4	30	53.6	56	100.0
Marital status
	Married	31	36.1	55	63.9	86	100.0	100.0
	Single	4	50.0	4	50.0	8	100.0
	Widowed	4	50.0	4	50.0	8	100.0
	Separated	6	54.5	5	45.5	11	100.0
Work situation
	Active	30	44.1	38	55.9	68	100.0	100.0
	Inactive	15	33.3	30	66.7	45	100.0
Body mass index
	Less than or equal to 30kg/m²	43	49.4	44	50.6	87	100.0	100.0
	More than 30 kg/m²	2	7.7	24	92.3	26	100.0
Smoking habit
	Non-smoker	12	46.1	14	53.9	26	100.0	100.0
	Smoker	17	38.6	27	61.4	44	100.0
	Ex-smoker	16	37.2	27	62.8	43	100.0
Risk consumption of alcohol
	Yes	7	35.0	13	65.0	20	100.0	100.0
	No	38	40.9	55	59.1	93	100.0
Arterial hypertension
	Yes	26	29.9	61	70.1	87	100.0	100.0
	No	19	73.1	7	26.9	26	100.0
Diabetes mellitus
	Yes	12	30.0	28	70.0	40	100.0	100.0
	No	33	45.2	40	54.8	73	100.0
Hypercholesterolemia
	Yes	13	27.1	35	72.9	48	100.0	100.0
	No	32	49.2	33	50.8	65	100.0
Practice of physical activity
	Yes	8	42.1	11	57.9	19	100.0	100.0
	No	37	39.4	57	60.6	94	100.0
Risk waist circumference
	Yes	15	22.7	51	77.3	66	100.0	100.0
	No	30	63.8	17	36.2	47	100.0
Risk neck circumference
	Yes	3	11.5	23	88.5	26	100.0	100.0
	No	42	48.3	45	51.7	87	100.0
Type
	NSTEMI^‡	19	35.8	34	64.2	53	100.0	100.0
	STEMI^§	26	43.3	34	56.7	60	100.0
Previous acute myocardial infarction
	Yes	8	25.0	24	75.0	32	100.0	100.0
	No	37	45.7	44	54.3	81	100.0

Sociodemographic and clinical variables	Crude OR*	IC 95% ^†	p	Adjusted OR ^‡	CI 95% ^†	p
Gender
	Male	1.00 (ref)
	Female	1.23	0.53;2.84	.629
Age group
	Less than 60 years	1.00 (ref)			1.00 (ref)
	More than or equal to 60 years	0.58	0.27;1.24	.156	0.27	0.09; 0.81	.019
Marital status
	Married	1.00 (ref)					.019
	Single	0.56	0.13; 2.41	.540
	Widower	0.56	0.13; 2.41
	Separated	0.47	0.13; 1.67
Work situation
	Active	-	-	-
	Inactive	-	-	-
Body mass index
	Less than or equal to 30kg/m²	1.00 (ref)			1.00 (ref)
	More than 30 kg/m²	11.73	2.61; 52.68	.001	6.92	1.19; 40.11	.031
Smoking habit
	Non-smoker	1.00 (ref)					.031
	Smoker	1.36	0.51; 3.63	.748
	Ex-smoker	1.45	0.54; 3.89
Risk consumption of alcohol
	Yes	1.28	0.47; 3.51	.627
	No	1.00 (ref)
Arterial hypertension
	Yes	6.37	2.39; 16.97	.0001	16.62	4.04; 68.37		.0001
	No	1.00 (ref)			1.00 (ref)
Diabetes mellitus
	Yes	1.93	0.85; 4.36	.116
	No	1.00 (ref)
Hypercholesterolemia
	Yes	2.61	1.17; 5.82	.018
	No	1.00 (ref)
Practice of physical activity
	Yes	0.89	0.33; 2.43	.823
	No	1.00 (ref)
Risk waist circumference
	Yes	6.00	2.62; 13.73	.0001	6.00	2.08; 17.32		.001
	No	1.00 (ref)			1.00 (ref)
Risk neck circumference
	Yes	7.16	2.00; 25.60	.002
	No	1.00 (ref)
Type
	NSTEMI^§	1.37	0.64; 2.92	.417
	STEMI^\|\|	1.00 (ref)
Previous AMI^¶
	Yes	2.52	1.01; 6.28	.046
	No	1.00 (ref)

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding Author: Carla Renata Silva Andrechuk Universidade Estadual de Campinas. Faculdade de Enfermagem Rua Tessália Vieira de Camargo, 126 Cidade Universitária "Zeferino Vaz" CEP: 13083-887, Campinas, SP, Brasil E-mail: andrechukma@yahoo.com.br