中重度阻塞性睡眠呼吸暂停对急性冠脉综合征患者心脏结构和功能的影响

摘要

Objective To investigate the effect of obstructive sleep apnea (OSA) on cardiac structure and function in patients with acute coronary syndrome (ACS).Methods A total of 767 patients with ACS consecutively hospitalized at the Emergency & Critical Care Center of Beijing Anzhen Hospital from June 2015 to May 2017 were enrolled in this study.There were 637 males and 130 females.Patients who met the inclusion criteria according to the sleep apnea hypopnea index (AHI) were examined with portable sleep respiration monitoring.Patients were divided into moderate or severe OSA group (AHI≥15,n=389) and non or mild OSA group (AHI＜15,n=78).The general information and echocar diographic results were analyzed.The data fitted normal distribution were compared between the groups with independent sample t test.Results The body mass index [(27.8±3.6) vs (25.8±3.4) kg/m2,t=-7.854,P＜0.01],neck circumference [(41.1±4.2) vs (39.3±3.2) cm,t=-6.717,P＜0.01] and waist-to-hip ratio (0.99±0.54 vs 0.97±0.53,t=-4.735,P＜0.01) at admission were significantly higher in moderate or severe OSA group than those in non or mild OSA group.The left ventricular end-diastolic diameter,inter-ventricular septum thickness,left atrial diameter,right atrial diameter were all significantly higher,and the E/A peak ratio was remarkably lower in the moderate or severe OSA group (t=-2.130,0.278,-3.045,-2.241,2.260,all P＜0.05).Conclusion Moderate or severe OSA may aggravate cardiac remodeling and diastolic function in ACS patients.%目的 探讨阻塞性睡眠呼吸暂停(OSA)对急性冠脉综合征(ACS)患者心脏结构和功能的影响.方法 人选2015年6月至2017年5月于北京安贞医院急诊危重症中心诊断为ACS的患者767例,其中男637例,女130例.所有患者行睡眠呼吸监测检查,根据睡眠呼吸暂停低通气指数(AHI)分中/重度OSA组(AHI≥15,n=389)和无/轻度OSA组(AHI＜15,n=78),分析超声心动图心脏结构和功能指标的差异.正态分布的计量资料组间比较采用独立样本t检验.结果 中/重度OSA组患者体质指数(BMI)[(27.8±3.6)比(25.8±3.4) kg/m2,t=-7.854,P＜0.01]、颈围[(41.1±4.2)比(39.3±3.2)cm,t=-6.717,P＜0.01]及腰臀比(0.99±0.54比0.97±0.53,t=-4.735,P＜0.01)明显高于无/轻度OSA组.与无/轻度OSA组相比,中/重度OSA组左室舒末内径、室间隔厚度、左房内径、右房内径明显升高,E峰/A峰明显下降(t=-2.130、0.278、-3.045、-2.241、2.260,均P＜0.05).结论 中重度OSA可能加重ACS患者心脏重构及舒张功能不全.