Obstructive sleep apnea is associated with the presence of coronary collaterals in patients with acute myocardial infarction

Background: In patients with coronary artery disease cardioprotective effects of obstructive sleep apnoea (OSA) are postulated due to intermittent hypoxia and hypoxemic preconditioning. The aim of this study was to investigate a potential association between OSA and coronary recruitment and collateral formation in patients with first-time acute myocardial infarction (AMI). Methods: In "Treatment of sleep apnoea Early After Myocardial infarction with Adaptive Servo-Ventilation trial" (TEAM-ASV I study; NCT02093377) patients with first AMI who received a coronary angiogram within 24 hours after onset of symptoms and a polygraphy within the first 3 days after AMI were examined. The coronary collaterals were classified by visual analysis using the Cohen-Rentrop (CR)-Score. A CR-Score ≥2 describes an at least partially retrograde filling of the occluded coronary. Results: Of the 94 analyzed patients (mean age 58 years, 81% male, body-mass index 29 kg/m²) 14% had coronary collaterals with a CR-Score ≥2. The apnoea-hypopnoe index (AHI) was significantly higher in patients with existing coronary collaterals (CR-Score ≥2) than in those without (31 [11;54] vs. 13 [4;27]; p=0.032). In a multivariable regression model the obstructive AHI was associated with the presence of coronary collaterals independently of age, sex, BMI, creatine kinase and 3-vessel disease (OR 1.06; 95% CI [1.01; 1.10]; p=0.018), whereas this could not be shown for the central AHI (OR 1.02; 95% CI [0.98; 1.06]; p=0.423). Conclusion: At the time of the first AMI, patients with OSA have an increased number of coronary collaterals, supporting potential cardioprotective effects of OSA.