Sleep Apnea and the Risk for Perioperative Myocardial Infarction

TO THE EDITOR:

The article by Ashton and colleagues [1] focused on the stratification of patients before noncardiac surgery in order to estimate the risk for perioperative myocardial infarction. Surprisingly, given the large number of patients (1487 men older than 40 years), they did not report a single case of obstructive sleep apnea, which is a risk factor for ischemic heart disease [2, 3]. Assuming a 1% prevalence of this syndrome in the general population (the lower limit of the many reported epidemiologic studies) [4], at least 15 patients might have had the syndrome before the intervention. We suggest that some patients who had perioperative myocardial infarction in that study had the obstructive sleep apnea syndrome, and their airway obstruction worsened because of the use of hypnotics and narcotics [5]. Appropriate diagnosis and treatment with nasally administered continuous positive airway pressure in the recovery room might have partly prevented the myocardial infarctions. Preoperative cardiac risk assessment should include questions about snoring and daytime hypersomnolence, as well as polysomnographic studies in symptomatic and high-risk patients (mainly those who are obese or hypertensive). In patients with the obstructive sleep apnea syndrome, studies are needed to confirm that continuous positive airway pressure has value in the perioperative period.