Impact of the Obstructive Sleep Apnea Syndrome (OSAS) on the Ventricular Remodeling After Acute Myocardial Infarction

Study Overview
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Brief Summary
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Coronary artery disease is a common and serious disease, the leading cause of death worldwide. Obstructive sleep apnea syndrome (OSAS) is common and often under-diagnosed in coronary artery disease where it could be involved in the pathophysiology and perhaps prognosis. The entanglement of the two pathologies is actually quite well known, in particular the consequences of one over the other just beginning to be studied. Understanding the pathophysiology through new imaging modalities should improve the management of patients to propose new approaches. SAS-IDM is an interventional and prospective study conducted at the University Hospital of Montpellier. Patients will be divided in three groups depending of the results of the polysomnography: 1/ AHI < 5/h: normal, without OSA ; 2/ 5/h ≤ AHI < 30/h: mild or moderate OSA ; 3/ IAH ≥ 30/h: severe OSA. A treatment by CPAP will be proposed to patients of the group severe OSA.

Official Title
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Impact of the Obstructive Sleep Apnea Syndrome (OSAS) on the Ventricular Remodeling After Acute Myocardial Infarction

Conditions
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Recent Acute Myocardial Infarction

Intervention / Treatment
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* Other: Without Obstructive Sleep Apnea (syndrome)
* Other: Mild or moderate Obstructive Sleep Apnea (syndrome)
* Other: Severe Obstructive Sleep Apnea (syndrome)
* Device: CPAP


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Provision of informed consent prior to any study specific procedures, Adults, men and women aged < 90 years, Hospitalized in Intensive Care Units, MI confirmed by the study of the coronary arteries (coronary angiography) in acute phase (primary coronary angiography) or secondarily (ambulatory IDM IDM initially reperfused by thrombolysis), Myocardial infarction defined the criteria normally applied (STEMI: ST segment depression greater than 2 mm in at least 2 contiguous leads or new onset of pain and a left bundle branch block), The score of delayed enhancement MRI should be greater than 5 segments of 17 during the first MRI (criterion of severity of AMI), The subject must be affiliated to a social security scheme Exclusion Criteria: Patients for whom CPAP equipment has demonstrated its usefulness regardless of cardiovascular context Patients sleepy (Epworth score> 13) Road Truckers Contraindication to achieve cardiac MRI (primary endpoint): known and crippling claustrophobia, metal clips intracranial, intraocular, presence of an implantable defibrillator presence of a pacemaker history of injury by firearm or shrapnel balance without known projections hypersensitivity to gadolinium products (or history of systemic sclerosis skin) or severe renal impairment with creatinine clearance <30 ml / min any other known cause of contra-indication. Mild infarction (rate of late enhancement MRI in less than or equal to 4 segments of 17 during the first MRI) Patient previously treated with CPAP prior MI or already experienced with sleep apnea syndrome. SAS whose central part is predominantly (> 50%) General Inability to understand the nature and goals of the study and / or communication difficulties with the investigator No affiliation to a French social security recipient or not such a scheme Major protected by law (guardianship, curators or under judicial protection) deprivation of liberty by judicial or administrative decision Increased likelihood of non compliance to the protocol or abandonment under study History or presence of psychoactive substance abuse pregnancy, become pregnant, or breastfeeding

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 89 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Without Obstructive Sleep Apnea (syndrome)<br>Subjects will be randomized after the results of the polysomnography (21st day ± 10) in one of this three groups | Other: Without Obstructive Sleep Apnea (syndrome)<br> <br> |
| Other: Mild or moderate Obstructive Sleep Apnea (syndrome)<br>Subjects will be randomized after the results of the polysomnography (21st day ± 10) in one of this three groups | Other: Mild or moderate Obstructive Sleep Apnea (syndrome)<br> <br> |
| Other: Severe Obstructive Sleep Apnea (syndrome)<br>Subjects will be randomized after the results of the polysomnography (21st day ± 10) in one of this three groups | Other: Severe Obstructive Sleep Apnea (syndrome)<br> <br> Device: CPAP<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in diameter (mm) and end diastolic and systolic LV volumes (mL) at 6 months of acute MI among a group of patients without OSA (AHI <5 / h) and a group of patients with mild to moderate OSA (AHI between 5 and 30 / h) |  | 6 months of acute MI | 
| Transmural enhancement (%) at 6 months of acute MI among a group of patients without OSA (AHI <5 / h) and a group of patients with mild to moderate OSA (AHI between 5 and 30 / h) |  | 6 months of acute MI | 
| Thickness of the LV wall (mm) at 6 months of acute MI among a group of patients without OSA (AHI <5 / h) and a group of patients with mild to moderate OSA (AHI between 5 and 30 / h) |  | 6 months of acute MI | 
| Presence no reflow at 6 months of acute MI among a group of patients without OSA (AHI <5 / h) and a group of patients with mild to moderate OSA (AHI between 5 and 30 / h) |  | 6 months of acute MI | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The difference in cardiac remodeling in cardiac MRI at 6 months between the three diagnostic categories |  | At 6 months after inclusion | 
| The difference in cardiac remodeling in cardiac MRI between the date of inclusion and 6 months between diagnostic categories. |  | Between the date of inclusion and 6 months | 
| The difference of left ventricular remodeling in cardiac MRI between the date of inclusion and 6 months in the severe OSA group based on the assumption (good compliance and effectiveness of PPC or not) |  | Between the date of inclusion and 6 months | 
| The occurrence of cardiovascular events during the first year following the IDM depending on the initial AHI index. |  | Between the date of inclusion and one year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Recent acute myocardial infarction, Obstructive sleep apnée (syndrome), Ventricular remodeling, Continuous Positive Airway Pressure