不同程度阻塞性睡眠呼吸暂停对非梗阻性肥厚型心肌病患者临床特征的影响

Impact of Severity of Obstructive Sleep Apnea on Clinical Features of Patients With NonobstructiveHypertrophic Cardiomyopathy

目的:研究阻塞性睡眠呼吸暂停(OSA)对非梗阻性肥厚型心肌病(HCM)患者临床特征的影响。方法:回顾性分析2010年2月至2018年12月间,我院诊断为非梗阻性HCM且行睡眠呼吸监测的患者共241例。记录患者的一般临床资料、超声心动图参数、睡眠呼吸监测参数等。根据呼吸暂停低通气指数(AHI)将患者分为无OSA组、轻度OSA组和中-重度OSA组,比较三组患者间的临床特点。结果:共有164例(68.0%)非梗阻性HCM患者合并OSA,中-重度OSA患者110例(45.6%)。三组患者年龄[(47.1±13.1)岁vs.(51.4±11.8)岁vs.(54.7±11.7)岁,P<0.001]和体重指数[(24.5±3.3)kg/m^(2) vs.(26.7±3.3)kg/m^(2) vs.(27.7±4.1)kg/m^(2),P<0.001]均随着OSA严重程度增加而增加。与无OSA组和轻度OSA组患者相比,中-重度OSA组患者男性患者比例更高,合并高血压、高脂血症、吸烟史、冠心病和NYHA心功能分级Ⅱ~Ⅲ级的患者比例更高(P均<0.05)。中-重度OSA组患者血清C反应蛋白水平高于无OSA组和轻度OSA组患者(P<0.05)。三组患者左心室射血分数和左心室舒张末期内径差异均无统计学意义(P均>0.05),但中-重度OSA组的左心房直径和升主动脉内径均显著大于无OSA组和轻度OSA组患者(P均<0.05)。中-重度OSA组睡眠期间平均心率也显著高于无OSA组和轻度OSA组患者(P<0.05)。Pearson相关分析显示,经过自然对数(ln)转换,ln(AHI+1)与左心房直径(r=0.176,P=0.006)和升主动脉内径(r=0.318,P=0.001)呈显著正相关。结论:OSA在非梗阻性HCM患者中非常常见,心血管代谢异常及心脏重构程度随OSA严重程度增加而增加,对该类患者应积极行睡眠呼吸监测筛查OSA。

Objective:To investigate the impact of obstructive sleep apnea(OSA)on clinical features of patients with nonobstructive hypertrophic cardiomyopathy(HCM).Methods:Clinical data of 241 patients with nonobstructive HCM,who underwent sleep studies from February 2010 to December 2018 at Fuwai Hospital,were retrospectively analyzed.Clinical characters,echocardiographic data,and parameters of sleep studies were obatained.Patients were grouped into non-OSA,mild OSA and moderate to severe OSA according to apnea-hypopnea index and clinical features were compared among groups.Results:A total of 164(68.0%)nonobstructive HCM patients were diagnosed with OSA and 110(45.6%)had moderate to severe OSA.Age([47.1±13.1]years vs.[51.4±11.8]years vs.[54.7±11.7]years,respectively,P<0.001)and body mass index([24.5±3.3]kg/m^(2) vs.[26.7±3.3]kg/m^(2) vs.[27.7±4.1]kg/m^(2),respectively,P<0.001)were increased in proportion to increasing severity of OSA.Compared with patients with non-OSA and mild OSA,patients with moderate to severe OSA were more often male (P<0.05), had a higher prevalence of hypertension, hyperlipidemia, smoking history, coronary heart diseaseand New York Heart Association functional class Ⅱ or Ⅲ (all P <0.05). Patients with more severe OSA also had elevatedlevel of serum C-reactive protein (P <0.001). Left ventricular ejection fraction and left ventricular end-diastolic diameterwere similar among groups (both P>0.05), meanwhile, patients with severe OSA had larger left atrial diameter and ascendingaortic diameter (both P<0.05). In addition, mean heart rate during sleep was higher in patients with moderate to severe OSAcompared those with non-OSA or mild OSA. ln (AHI+1) value was positively correlated with left atrial diameter (r =0.176,P=0.006) and ascending aortic diameter (r =0.318, P=0.001).Conclusions: Prevalence of OSA is high in patients with nonobstructive HCM and severity of OSA corelates withmetabolic abnormalities and cardiac remodeling parameters. Clinicians are encouraged to apply diagnostic sleep evaluation toscreening OSA in these patients.