Day–Night Variation of Acute Myocardial Infarction in Obstructive Sleep Apnea
Open accessAbstract
OBJECTIVES To evaluate the day-night variation of acute myocardial infarction (MI) in patients with obstructive sleep apnea (OSA). BACKGROUND OSA has a high prevalence and is characterized by acute nocturnal hemodynamic and neurohormonal abnormalities that may increase the risk of MI during the night. METHODS AND RESULTS We prospectively studied 92 patients with MI, for which the time of onset of chest pain was clearly identified. The presence of OSA was determined by overnight polysomnography. For patients with and without OSA we compared the frequency of MI during different intervals of the day based on the onset time of chest pain. The groups had similar prevalence of comorbidities. MI occurred between midnight and 6am in 32% of OSA patients and 7% of non-OSA patients (P=0.01). The odds of having OSA in those patients whose MI occurred between midnight and 6am was six-fold higher than in the remaining 18 hours of the day (95% C.I: 1.3 −27.3, P=0.01). Of all patients having an MI between midnight and 6am, 91% had OSA. CONCLUSIONS The diurnal variation in the onset of MI in OSA patients is strikingly different from the diurnal variation in non-OSA patients. Patients with nocturnal onset of MI have a high likelihood of having OSA. These findings suggest that OSA may be a trigger for MI. Patients having nocturnal onset of MI should be evaluated for OSA, and future research should address the effects of OSA therapy for prevention of nocturnal cardiac events. CONDENSEND ABSTRACT We studied 92 patients with MI, for whom the time of onset of chest pain was clearly identified. MI occurred between midnight and 6am in 32% of OSA patients and 7% of non-OSA patients (P=0.01). The odds of having OSA in those patients whose MI occurred between midnight and 6am was 6 fold higher than in the remaining 18 hours of the day (95% C.I: 1.3 −27.3, P=0.01). The diurnal variation in the onset of MI in patients with OSA is strikingly different; patients with nocturnal onset of MI have a high likelihood of having OSA.
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The onset of myocardial infarction is more likely to occur during the nighttime.
“In addition, the onset of MI is more likely to be during the nighttime.666”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [666]
The Discussion says nighttime MI onset is increased in patients with obstructive sleep apnea compared with patients without it. It also says patients without sleep apnea have a nighttime nadir and a morning peak, like the general population. The unqualified claim that MI onset is more likely at night therefore reverses the paper’s general finding. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredPatients with prior STEMI are more likely than the general population to have OSA and have worse event-free survival compared with STEMI patients without OSA.
“Patients who have had prior STEMI are more likely than the general population to have OSA, and have worse event free survival compared to STEMI patients without OSA.666,670”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [666]
The Abstract says OSA prevalence is 2- to 3-fold higher in patients with a history of myocardial infarction, but it does not specify STEMI. The Results and Conclusions examine the time of MI onset, not event-free survival; the paper does not support the claimed survival comparison. Page numbers are not provided for these passages. (LLM, conf=0.88)
Experimental — accuracy not yet measuredDuring obstructive apneas, increased adrenergic tone and hypoxemia may increase the risk of myocardial ischemia.
“During obstructive apneas, increased adrenergic tone and hypoxemia may increase the risk of myocardial ischemia.666,667”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [666]
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Self-citation
- Authors
- Sert Kuniyoshi, F. H., Garcia-Touchard, A., Gami, A. S., Romero-Corral, A., van der Walt, C., Pusalavidyasagar, S., Kara, T., Caples, S. M., Pressman, G. S., Vasquez, E. C., Lopez-Jimenez, F., & Somers, V. K.
- Affiliations
- Mayo Clinic (US)
- Yeshiva University (US)
- Universidade Federal do Espírito Santo (BR)
- Corresponding author
- Somers, Virend K.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2008-07
- Volume
- 52
- Issue
- 5
- Pages
- 343-346
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC2598735
- OpenAlex
- W2005565772
- Semantic Scholar
- a386a00d1253d7df22848c2f33efe383f1b1967d
- Cited by
- 268
- References
- 23
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 7 · 2023: 11 · 2022: 8 · 2021: 13 · 2020: 9 · 2019: 6 · 2018: 12 · 2017: 14 · 2016: 20 · 2015: 24 · 2014: 25 · 2013: 20 · 2012: 24
- FWCI
- 14.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- The Medicine Forum (submittedVersion)
- Funders
- American Heart Association
- GlaxoSmithKline
- ResMed
- National Institutes of Health (HL-65,176, RR-00585)
- Respicardia
- National Heart, Lung, and Blood Institute (HL65176, R01HL065176)
- National Center for Research Resources (M01RR000585)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- obstructive sleep apnea, acute myocardial infarction, diurnal variation, polysomnography
- MeSH terms
- Aged, Chest Pain, Circadian Rhythm, Female, Humans, Male, Middle Aged, Myocardial Infarction, Prospective Studies, Polysomnography, Sleep Apnea, Obstructive
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