睡眠呼吸障碍对冠心病患者冠状动脉病变严重程度的影响

The effect of sleep disordered breathing on severity of coronary lesions in patients with coronary artery disease

目的 探讨睡眠呼吸障碍（SDB）对冠心病（CAD）患者冠状动脉病变严重程度的影响。方法 连续入选2015年6月至2017年6月首都医科大学北京安贞医院急诊危重症中心住院的CAD患者824例，所有患者接受冠状动脉造影，并于入院7天内行睡眠呼吸监测检查。根据睡眠呼吸暂停低通气指数（AHI），将患者分为SDB（AHI≥15次/小时）和非SDB（AHI〈15次/小时）两组，计算SYNTAX评分与残余SYNTAX评分，评价两组冠状动脉病变严重程度的差异。结果 SDB患者占51.5%（424/824）。与非SDB组相比，SDB组男性比例更高（86.1% vs. 80.8%，P〈0.05），体质指数更高（27.56±3.46 vs. 25.80±3.32，P〈0.05）；SDB组高血压和既往经皮冠状动脉介入治疗（PCI）的比例高于非SDB组；SDB组2支以上病变比例更高（P〈0.05），更多的接受了PCI（P〈0.05）和支架术（P〈0.05）。与非SDB患者相比，SDB患者SYNTAX评分有升高趋势（中位数13 vs. 11，P=0.08），PCI后残余SYNTAX评分SDB组明显高于非SDB组（中位数6 vs. 4，P〈0.05）。结论 冠心病合并SDB患者冠状动脉病变程度更为严重，完全血运重建比例较低，其远期预后影响尚需进一步研究。

Objective To analyze the effect of sleep disordered breathing （SDB） on severity of coronary lesions in patients with coronary artery disease （CAD）. Methods From June 2015 to June 2017, a total of 824 patients admitted for CAD in Beijing Anzhen Hospital, Capital Medical University were enrolled. Patients received coronary angiography and underwent sleep study within 7 days after admission. According to apnea hypopnea index （AHI）, the patients were divided into non-SDB （AHI 〈 15/h） and SDB （AHI ≥ 15/h） groups. SYNTAX score and residual SYNTAX score were calculated. Results The prevalence of SDB was 51.5% （424/824）. There were more male patients in the SDB group than that in the non-SDB group （86.1% vs 80.8%, P〈0.05 ）.The body mass index was higher in the SDB group （27.56±3.46 vs. 25.80±3.32, P〈0.05）. In the SDB group, there were more patients with hypertension and history of PCI. Moreover, the SDB patients had more multi-vessel diseases （P〈0.05） and underwent more PCI procedures （P〈0.05） and stenting （P〈0.05）. The SYNTAX score tended to be increased （median 13 vs. 11, P〈0.05） in the SDB group. The residual SYNTAX score in the SDB group was higher than that in the non-SDB Group （median 6 vs. 4, P〈0.05）. Conclusion Patients with CAD and concomitant SDB had more lesions compared to those without SDB and had lower rate of complete revascularization. The prognostic impact of SDB needs further study.