阻塞性睡眠呼吸暂停低通气综合征与冠心病的相关性

A study on the association of obstructive sleep apnea hypopnea syndrome with coronary atherosclerosis and coronary heart disease

目的进一步探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与冠心病以及冠状动脉粥样硬化的相关性。方法以2005年3至12月南京医科大学第一附属医院心脏科连续收治的82例患者为研究对象,依据多导睡眠仪监测得出的睡眠呼吸暂停低通气指数(AHI)分为轻度 OSAHS 组(5<AHI<20,38例)、中重度 OSAHS 组(AHI>20,20例)和非 OSAHS 组(对照组,AHI<5,24例)。3组均进行冠状动脉造影及 Gensini 评分,后者用于评估冠状动脉粥样硬化病变的程度。结果轻度和中重度 OSAHS 组 AHI 的中位数(10.9和29.3次/h)显著高于对照组(2.9次/h),最低血氧饱和度[(84±9)%和(81±9)%]显著低于对照组[(89±6)%];冠心病发病率[66%(25/38)和95%(19/20)]显著高于对照组[29%(7/24)];冠状动脉病变单支受累百分率[24%(9/38)和20%(4/20)]显著高于对照组[17%(4/24)],多支受累百分率[42%(16/38)和80%(16/20)]显著高于对照组[12.5%(3/24)];中重度 OSAHS 组的 Gensini 评分中位数(35.0)显著高于对照组(1.0),AHI 与Gensini 评分呈显著正相关。结论 OSAHS 可能是导致冠状动脉粥样硬化和冠心病的一个重要的独立危险因素,建议将其列入冠心病的二级预防。

Objective To investigate the association of obstructive sleep apnea hypopnea syndrome （OSAHS） with coronary atherosclerotic disease （CAD）. Methods From March of 2005 to December of 2005, 82 subjects admitted into Department of Cardiology of The First Affiliated Hospital of Nanjing Medical University were recruited. They were divided into three groups based on their nocturnal apnea hypopnea index （AHI） detected by examination of polysemnography （PSG） ： mild OSAHS group （ 5 〈 AHI ≤ 20,38 cases）, moderate-to-severe group （ AHI 〉 20,20 cases）and control group （ AHI 〈 5,24 cases ）. Coronary artery angiography and Gensini Score for assessing the severity of coronary atheroeclerosis were performed in all three groups. Results Compared with the control group, the apnea-hypopnea index （AHI） was significantly higher in OSAHS groups [ 10.9（7.7 - 15.2） ,29. 3（23. 3 -48.4） vs 2. 9（ 1.9 -3.8） ]. The minimal SpO2 was significantly lower （84±9）%, （81 ±9）% in OSAHS groups than that in the control group （89±6）%. The incidence of CAD was significantly higher [66% （25/38）and 95% （19/20） ] in OSAHS groups than in the control group [ 17% （4/24） ]. The percentage of patients with single-coronaryvessel disease was 24% （9/38）in mild OSAHS group, 20% （4/20）in moderate-to-severe OSAHS group, and 17% （4/24） in control group. The patients with multi-coronary-vessel disease were 42% （16/38） in mild OSAHS group, 80% （16/20） in moderate-to-severe OSAHS group, and 12. 5% （3/24） in control group. Gensini Score was significantly higher in moderate-to-severe OSAHS group than that in control group [35.0（ 16. 5 -87. 0）, 1.0（0. 0 -5.0） ]. Moreover, a positive correlation was revealed between AHI and Gensini Score. Conclusion OSAHS may be a significant independent risk factor of coronary atherosclerosis and CAD and should be taken into account in CAD secondary prevention.