非体外循环冠状动脉旁路移植术后新发心房颤动发生与阻塞性睡眠呼吸暂停的相关性分析

Effect of obstructive sleep apnea on atrial fibrillation after off-pump coronary artery bypass grafti

目的:非体外循环冠状动脉旁路移植术(OPCABG)患者术后新发心房颤动(POAF)的影响因素较多,阻塞睡眠呼吸暂停(OSA)在该部分患者中发生率较高。因此,本研究旨在了解OSA是否与这部分患者POAF相关。方法:本研究前瞻性分析了2019年至2020年我科行OPCABG术患者74例,所有患者入院后行睡眠呼吸监测,且将术后持续超过5min或需要抗心律失常或心电复律治疗的心房颤动的患者。结果:接受OPCABG术者以男性居多,为52(72.2%)例。其中,共有46(63.9%)例患者诊断为OSA,其中包括24(33.3%)例轻度、22例(30.5%)中重度患者。而合并阻塞性睡眠呼吸暂停患者POAF的发生率明显较高(14.3%vs.37.5%vs.45.5%, P=0.02);在不同组别中,发生POAF患者的睡眠呼吸暂停低通气指数也明显较高,轻度组[(8.8±2.3) vs.(11.3±1.8), P=0.009];中重度组[(21.4±7.3) vs.(35.2±8.7),P=0.001]。此外,合并存在OSA患者高血压、糖尿病、介入治疗史等发生比例均较高。经过多因素回归分析,并经性别、年龄、BMI校正后发现,只有LAD(OR=5.4,95%CI:1.0~28.5,P=0.04)、心功能分级(OR=1.78,95%CI:1.02~2.46,P=0.05)和中重度阻塞性睡眠呼吸暂停与这部分患者POAF的发生呈相关。结论:LAD、心功能分级和睡眠呼吸暂停低通气指数是行OPCABG术后POAF发生的危险因素。

Objective: There are many influencing factors of new onset atrial fibrillation after off-pump coronary artery bypass grafting(OPCABG), and the incidence of obstructive sleep apnea(OSA) is higher in this part of patients. Therefore, the purpose of this study is to understand whether OSA is associated with new onset AF in these patients. Methods: This study prospectively analyzed 74 patients who underwent OPCABG in our department from 2019 to 2020. All patients underwent sleep test after admission, and atrial fibrillation lasting more than 5 minutes or requiring antiarrhythmic or cardioversion therapy was defined as postoperative new onset atrial fibrillation.Results: In our study, 52(72.2%) patients underwent OPCABG.Among them, 46(63.9%) patients were diagnosed with OSA, including 24(33.3%) mild patients and 22(30.5%) moderate and severe patients. The incidence of new atrial fibrillation was significantly higher in patients with OSA(14.3% vs.37.5% vs.45.5%, P = 0.02);In different groups, the sleep apnea hypopnea index of patients with postoperative atrial fibrillation was also significantly higher mild group: [(8.8±2.3)vs.(11.3±1.8),P=0.009];Moderate and severe group: [(21.4±7.3)vs.(35.2±8.7),P =0.001].In addition, the incidence of hypertension, diabetes, interventional therapy history in patients with OSA were higher. After multivariate regression analysis and adjustment for gender, age and body mass index, only left atrial diameter(OR=5.4,95% CI:1.0~28.5,P =0.04), cardiac function classification(OR=1.78,95% CI:1.02-2.46,P =0.05) and heart function classification and moderate-severe OSA were independently associated with the occurrence of new atrial fibrillation in these patients. Conclusions: In our study, left atrial diameter, cardiac function grade and sleep apnea hypopnea index are risk factors for new onset AF after OPCABG and sleep apnea hypopnea index is an important indicator of the severity of OSA.