肥厚型梗阻性心肌病合并阻塞性睡眠呼吸暂停患者的临床特点分析

Clinical features of patients with hypertrophic obstructive cardiomyopathy combining obstructive sleep apnea

目的研究肥厚型梗阻性心肌病(HOCM)合并阻塞性睡眠呼吸暂停(OSA)患者的临床特点。方法选择2010至2018年间,阜外医院诊断为HOCM且行睡眠呼吸监测的患者共299例进行回顾性分析。记录患者的一般临床资料、超声心动参数、睡眠呼吸监测参数等。根据呼吸暂停低通气指数(AHI)≥5次/h诊断为OSA,并比较有无OSA两组患者的临床特点。结果共有156例(52.2%)HOCM患者诊断为OSA。与无OSA患者相比,OSA患者年龄更大[(54±10)比(45±14)岁,P<0.001],体质指数更高[(27±3)比(25±3)kg/m2,P<0.001],合并高血压[54.4%(85/156)比21.0%(30/143),P<0.001]、高脂血症[37.2%(58/156)比13.3%(19/143),P<0.001]、吸烟史[48.1%(75/156)比35.0%(50/143),P=0.022]的比例更高。OSA组患者美国纽约心脏病学会心功能分级Ⅱ或Ⅲ级比例(P=0.017)和心房颤动比例(P=0.005)更高,收缩压、舒张压、空腹血糖和血清超敏C-反应蛋白(hs-CRP)水平均高于无OSA患者(均P<0.001)。OSA组患者超声心动测得左室舒张末内径及升主动脉内径明显高于无OSA组患者(P<0.001)。AHI指数与左室舒张末内径(r=0.346)、升主动脉内径(r=0.357)及血清hs-CRP水平成显著正相关(r=0.230)(均P<0.001)。结论HOCM患者常合并OSA,OSA严重程度与心脏重构及血清炎症水平呈正相关。对HOCM患者应积极行睡眠呼吸监测筛选OSA,积极治疗OSA有可能改善HOCM患者的临床预后。

Objective To investigate the clinical features of patients with hypertrophic obstructive cardiomyopathy (HOCM) combined with obstructive sleep apnea (OSA).Methods From 2010 to 2018, a total of 299 patients who were diagnosed with hypertrophic cardiomyopathy and underwent sleep monitoring at Fuwai Hospital were retrospectively analyzed. General clinical features, data of echocardiography, and sleep breathing parameters were recorded. OSA was diagnosed by apnea-hypopnea index ≥ 5 events/hour. Clinical characteristics were compared between patients with and without OSA.Results A total of 156 (52.2%) HOCM patients were diagnosed with OSA. Compared with patients without OSA, patients with OSA were older((54±10) years vs (45±14) years, P<0.001), had a higher body mass index ((27±3) kg/m2 vs (25±3) kg/m2, P<0.001), a higher prevalence of hypertension (54.4% (85/156) vs 21.0% (30/143), P<0.001), hyperlipidemia (37.2% (58/156) vs 13.3% (19/143), P<0.001) and smoking history (48.1% (75/156) vs 35.0% (50/143), P=0.022). Patients with OSA also had a higher incidence of New York Heart Association functional class Ⅱ or Ⅲ (P=0.017), atrial fibrillation (P=0.005), and higher levels of systolic and diastolic blood pressure, fast glucose and high-sensitive c-reactive protein (all P<0.001). Left ventricular end-diastolic diameter as well as ascending aorta diameter in patients with OSA were also greater than those without OSA (both P<0.001). Apnea-hypopnea index (AHI) value positively correlated with left ventricular end-diastolic diameter (r=0.346), ascending aorta diameter (r=0.357) and high-sensitive c-reactive protein (r=0.230) (all P<0.001).Conclusions A high prevalence of OSA occurs in patients with HOCM. Severity of OSA correlates with cardiac remodeling and serum inflammatory factor level. As for HOCM patients, clinicians should actively monitor the sleep breathing parameters in order to recognize and treat potential OSA, thereby improving the prognosis of patients with HOCM.