急性冠脉综合征与睡眠呼吸障碍严重程度相关性的研究

Relationship Between Acute Coronary Syndrome and the Severity of Sleep Apnea Syndrome

目的:研究急性冠脉综合征患者心肌缺血程度与睡眠呼吸障碍(SDB)严重程度是否相关。方法:对2004-10至2007-06间用便携式睡眠监测仪对我院心内科监护室住院的256例急性冠脉综合征患者在入院3天内行睡眠检测。对检测结果中的睡眠呼吸暂停低通气指数、最低血氧饱和度、氧减饱和度指数、中枢性低通气指数、阻塞性低通气指数及急性冠脉综合征严重程度进行分析。分别将睡眠呼吸暂停低通气指数<5、≥5<20及≥20分为无SDB、轻度SDB与重度SDB患者。同时对不稳定性心绞痛组(102例)患者进行Braunwld分级,对急性心肌梗死组(154例)患者进行Killip分级及心电图记分评估梗死面积。结果:不稳定性心绞痛组中轻、重度SDB患者共占41.18%(42/102)。BraunwaldⅢ级患者在无SDB、轻度SDB和重度SDB中的构成比分别为16.67%(10/60)、23.33%(7/30)、25.00%(3/12)。不稳定性心绞痛组中轻、重度SDB患者睡眠呼吸暂停低通气指数、阻塞性低通气指数及氧减饱和度指数随Braunwald级别增高呈增加趋势,但无统计学意义(P>0.05)。急性心肌梗死组中轻、重度SDB患者共占48.70%(75/154)。KillipⅢ级患者在无SDB、轻度SDB和重度SDB中的构成比分别为12.66%(10/79)、28.20%(11/39)、41.67%(15/36)。急性心肌梗死组中轻、重度SDB患者睡眠呼吸暂停低通气指数、氧减饱和度指数、中枢性低通气指数和阻塞性低通气指数的程度随着Killip心脏功能分级和心肌梗死面积增加而呈加重趋势;肌钙蛋白T和肌酸激酶同功酶浓度随着Killip分级增高和心肌梗死面积增加而呈升高趋势;但只有KillipⅢ级与KillipⅠ级的差异有统计学意义(P<0.05)。结论:急性心肌梗死患者心肌缺血程度与SDB严重程度具有相关性,睡眠检测可能会成为急性心肌梗死严重程度的观察指标之一,而不稳定性心绞痛患者心肌缺血程度与SDB严重程度也有一定相关性但无统计学意义。

Objective ：To investigate the relationship between the degree of cardiac ischemia and the severity of sleep-disordered breathing（SDB） in patients with acute coronary syndrome（ACS）. Methods ： A total of 256 ACS patients treated in our hospital from October 2004 to June 2007 were recruited. The patients including 102 unstable angina（UA） and 154 acute myocardial infarction（AMI）. Polysomnography were done within 3 days of patients＇ hospitalization. The apnea-hypopnea index（ AHI）, nocturnal lowest SaO2, central apnea index （CAI）and obstructive apnea index were examined. Patients with UA were divided into 3 groups according to Braunwald classification and patients with AMI were classified into 4 groups according to Killip classification. ECG scoring system was performed to estimate the myocardial infarct size. Results：There were 45.7% of ACS patients suffered from SDB（AHI 〉5）.42/102（41.18% ）UA patients were accompanied with SDB, no significant correlation was found between the severity of SDB with the grades of Braunwald classification. There were 75/154 （48. 7% ）of AMI patients accompanied with SDB,and the severity of sleep apnea syndrome was positively correlated with the grades ofKillip classification and myocardial infarct size（P 〈0. 05）. Compared with UA patients,more CAI was found in AMI patients. Conclusion： SDB was associated with the degree of myocardial ischemia in patients with AMI, and polysomnography might be a reliable examination for estimating the severity of AMI. There was no significant correlation between the degree of myocardial ischemia and the severity of SDB in patients with UA.