阻塞性睡眠呼吸暂停在急性冠状动脉综合征住院患者中的患病情况及治疗现状

Prevalence and treatment of obstructive sleep apnea in hospitalized patients with acute coronary syndrome

目的分析急性冠状动脉综合征(acute coronary syndrome,ACS)住院患者中阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)的检出率及持续气道正压通气(continuous positive airway pressure,CPAP)的干预治疗情况。方法本研究为单中心、前瞻性队列研究,连续入选2015年6月至2020年1月期间于首都医科大学附属北京安贞医院急诊冠心病病房住院的ACS患者,对所有入选患者行便携式睡眠呼吸监测检查。依据睡眠呼吸暂停低通气指数(apnea-hypopnea index,AHI)诊断OSA患者(AHI≥5次/h),轻度OSA患者(15次/h>AHI≥5次/h),中度OSA患者(30次/h>AHI≥15次/h),重度OSA患者(AHI≥30次/h)。对诊断OSA患者,采用Epworth嗜睡量表(ESS)进行评分并定义合并日间嗜睡患者(ESS评分≥9分),并在出院后进行随访,记录患者是否接受CPAP治疗及治疗时长,评估其依从性,计算各组患者OSA检出率和治疗率。结果在1999例ACS住院患者中,既往有OSA病史患者71例(3.6%),新诊断OSA患者1655例(82.8%),共计检出OSA患者1726例(86.3%),其中轻度OSA患者663例(33.1%),中度OSA患者542例(27.1%),重度OSA患者521例(26.1%)。本研究ACS住院患者中诊断轻度OSA合并日间嗜睡、中/重度OSA、中/重度OSA合并日间嗜睡患者应用CPAP干预率低,分别为0.7%、5.7%、6.9%。结论ACS住院患者中OSA疾病检出率高,且检出多为中、重度OSA患者,存在OSA严重诊断不足现状。不同程度OSA患者(尤其中、重度患者)的CPAP干预率低,未来亟需探索提高检出率和干预率的有效措施。

Objective To investigate the detection rate of obstructive sleep apnea and the intervention of continuous positive airway pressure ventilation in the hospitalized patients with acute coronary syndrome.Methods This study is a single-center,prospective cohort study.ACS patients who were hospitalized in the emergency coronary heart disease ward of Beijing Anzhen Hospital,Capital Medical University from June 2015 to January 2020 were consecutively selected.Portable sleep apnea monitoring was performed on all selected patients.According to the sleep apnea-hypopnea index(AHI),OSA patients(>AHI≥5 times/h),mild OSA patients(15 times/h>AHI≥5 times/h),moderate OSA patients(30 times/h>AHI≥15 times/h),and severe OSA patients(AHI≥30 times/h)were diagnosed.The patients were scored using the Epworth Sleepiness Scale(ESS)to define the patients with daytime sleepiness(ESS score≥9).The patients were followed up after discharge to record whether the patients received CPAP treatment and the duration of treatment,and to evaluate their compliance and calculate the detection rate and treatment rate of OSA in each group.Results A total of 1999 inpatients with ACS were enrolled in this study.There were 71 patients(3.6%)with previous history of OSA,1655 patients(82.8%)with newly diagnosed OSA,and in all 1726 patients(86.3%)with OSA were detected,including 663 patients(33.1%)with mild OSA,542 patients(27.1%)with moderate OSA and 521 patients(26.1%)with severe OSA.The CPAP intervention rates of the ACS patients with mild OSA combined with daytime sleepiness,moderate/severe OSA and moderate/severe OSA combined with daytime sleepiness were low,which were 0.7%,5.7%and 6.9%respectively.Conclusions The detection rate of OSA disease in ACS inpatients is high,and most of them were moderate and severe OSA patients.There is a serious lack of diagnosis of OSA.The CPAP intervention rate of the patients with different degrees of OSA(especially moderate and severe patients)is low.It is urgent to explore effective measures to improve the detection rate and intervention rate in the future.