冠心病的危险因素-睡眠呼吸暂停

A RISK FACTOR OF CORONARY ARTERY DISEASE-SLEEP APNEA

目的 :睡眠呼吸暂停 (Sleepapnea,SA)与一定的心血管后遗症及心血管病死亡率的升高相关。本研究的目的是估测在症状性心绞痛和经冠状动脉造影证实的冠心病患者中SA的发生情况。另外 ,我们分析了SA与其它冠心病危险因素的关系。方法 :对 178名经冠状动脉造影证实的男性冠心病患者及 5 2名非冠心病的男性患者在睡眠实验室进行了整夜的多导睡眠监测 ,回归分析评估危险因素与冠心病的相关性。结果 :33.6 %的冠心病患者并发SA ;对照组有 2 0 .1%并发SA。冠心病患者平均呼吸暂停 /低通气指数 (Apnea/hy popneaindex ,AHl)显著高于对照组 (P <0 .0 5 )。冠心病合并SA患者的体重指数 (Body -mass-index ,BMl)显著高于单纯冠心病患者 (P <0 .0 1)。两组患者左室射血分数及其它危险因素之间相比无明显不同。高脂血症 (OR2 .4 ;P <0 .0 1)及AHI≥ 2 0的SA(OR2 .1;P <0 .0 5 )与心肌梗死独立相关。结论 :经冠状动脉造影证实的冠心病患者中SA的发生率较高。中度以上 (AHI≥ 2 0 )的SA是心肌梗死的独立危险因素。因此 ,对于冠心病患者提高对SA的警惕性是非常重要的。

Objective:Sleep apnea (SA) is associated with a range of cardiovascular sequelae and increased cardiovascular mortality. The aim of this study was to assess the prevalence of SA in patients with symptomatic angina and angiographically verified coronary artery disease (CAD). In addition, we analyzed the association of SA and other coronary risk factors with CAD. Methods:The overnight sleep study was performed in the sleep laboratory in 178 male patients with angiographically verified CAD and in 52 male patients with exclusion of CAD. A regression analysis was performed to assess associations between risk facters and CAD.Results:CAD patients were found to have SA in 33.6%, whereas SA was found in control subjects in 20.1%. the mean apnea/hypopnea index (AHI) was significantly higher ( P <0.05) in CAD patients than in control subjects. Body-mass-index (BMI) was significantly higher in patients with CAD and SA than in patients with CAD and without SA ( P <0.01 ) No significant difference was found with regard to left ventricular ejection fraction (LVEF) and other risk factors between both groups. Hyperlipidemia (OR 2.4; P <0.01) and SA defined as AHI ≥20 (OR 2.1; P <0.05) were independently associated with myocardial infarction.Conclusions: There is a high prevalence of SA among patients with angiographically proven CAD. SA of moderate severity (AHI≥20) is independently associated with myocardial infarction. Thus, for patients with CAD,particular vigilance for SA is important.