Clinical outcomes and plaque characteristics in patients with coronary artery disease and concomitant sleep-disordered breathing treated by continuous positive airway pressure

Background: Sleep-disordered breathing (SDB) is a risk factor for recurrent adverse events in patients with coronary artery disease (CAD). However, the prognosis of continuous positive alveolar pressure (CPAP) treatment for SDB with CAD remains unknown. Methods: A total of 281 consecutive patients with stable CAD requiring percutaneous coronary intervention (PCI) were included and classified into three groups according to the concomitance of SDB and CPAP treatment (untreated SDB group, n = 61; CPAP-SDB group, n = 24; and non-SDB group, n = 138). The incidence of major adverse cardiac and cerebrovascular events (MACCEs) within a year after PCI was compared between the three groups. The characteristics of the culprit plaques, including macrophage accumulation, were further assessed using optical coherence tomography. Results: The incidence of MACCEs was significantly different among the three groups (p = 0.037), with the highest incidence in the untreated-SDB group (22.9%) and 8.3% and 10.1% in the CPAP-SDB and non-SDB groups, respectively. The incidence of MACCEs at 1 year was significantly lower in patients with appropriate CPAP use than that in inadequately treated patients with SDB (0.0 vs. 22.5%, p = 0.048). Macrophage accumulation differed significantly among the three groups, with the highest accumulation in the untreated SDB group. Conclusions: CPAP treatment for SDB may be associated with a lower incidence of MACCEs following PCI and a lower prevalence of macrophages in the culprit plaques.