阻塞性睡眠呼吸暂停低通气综合征与冠状动脉病变程度的关系

The relation between obstructive sleep apnea hypopnea syndrome and the severity of coronary atherosclerosis in coronary artery disease

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的严重程度与冠状动脉病变程度的关系。方法对经冠状动脉造影确诊为冠心病的231例患者在病情允许的情况下进行多导睡眠图监测，根据呼吸暂停低通气指数（AHI）分为4组（重度组、中度组、轻度组、OSAHS阴性组）。根据冠状动脉造影结果计算每例患者的Gensini积分，分析OSAHS严重程度与Gensini积分的关系。结果72．72％（168／231）的冠心病患者AHI≥10次／h。重度组75．00％（33／44）、中度组61．12％（41／67）、轻度组38．60％（22／57）、OSAHS阴性组30．16％（19／63）的患者冠状动脉病变在3支及3支以上。重度组Gensini积分明显高于其他3组。多元线性回归分析显示，AHI与Gensini积分呈正相关（r=0．561，P〈0．001）。结论OSAHS是冠心病发生、发展的重要危险因素之一，OSAHS程度越重，冠状动脉病变程度越重。

Objective To investigate the relation between obstructive sleep apnea hypopnea syndrome （OSAHS） and the Gensini score, which is given to define the severity of coronary atheroselerosis, based on coronary angiograms findings, in patients with coronary artery disease. Methods We examined the apnea hypopnea index （AHI） using polysomnography （PSG） in 231 consecutive patients with coronary artery disease （ejection fraction, 〉40% ） that was diagnosed hy coronary angiography, 160 patients with angina pectoris and 71 patients with myocardial infarction. The Gensini score was calculated for each patient from the coronary arteriogram. The patients were classified into the following four groups according to the AHI, serious group： AHI 〉40 events per hour, 44 patients; moderate group： 20 events per hour 〈 AHI≤40 events per hour, 67 patients; mild group： 10 events per hour ≤ AHI ≤20 events per hour, 57 patients; OSAHS （ - ） group： AHI 〈 10 events per hour, 63 patients. Then the groups were examined for the relation between the AHI and the Gensini score. Results Of the total number of patients, 72.72% （ 168/231 ） had an AHI of more than ten per hour. The prevalence of multivessel disease （ ≥ 3 vessels ） was 75.00% （33/44）in serious group, 61.12% （41/67）in moderate group, 38.60% （22/57） in mild group, and 30. 16% （ 19/63 ） in OSAHS （ - ） group. The Gensini score was significantly higher in serious group than the other three groups. The Gensini score was higher in moderate group than mild group and OSAHS （ - ） group, and the Gensini score in mild group was higher than that in OSAHS （ - ） group. The Gensini score showed a significant positive correlation with the AHI （ r = 0. 561, P 〈 0. 001 ） in all patients. Multiple regression analysis showed that AHI was the most significant, independent determinant of the Gensini score among the coronary＂ risk factors tested, and that it explained 31.4% of the variances. Conclusion These findings suggest that AHI which is used to assess the severity of OSAHS is an important contributor to coronary atheroselerosis in the patients with cardiovascular disease, and the patients with more serious OSAHS would have more serious and complex coronary artery lesions.