阻塞性睡眠呼吸暂停患者的心脏早期损伤

Early cardiac injury in patients with obstructive sleep apnea

目的:评估尚无心血管症状的单纯阻塞性睡眠呼吸暂停(OSA)造成的心脏早期损害。方法:将随机纳入的92例OSA患者依照呼吸暂停低通气指数(AHI)分为轻、中、重三组(轻度25例,中度30例,中度36例),另取正常健康者25例作为正常对照组,分析血清中脑钠肽N末端前体(NT-proBNP)、心脏型脂肪酸结合蛋白(hFABP)及超声心动参数的变化状况来评估OSA患者的早期心脏损伤。随机选取中、重度30例(重度20例,中度10例) OSA患者予以持续正压通气(CPAP)治疗一个月,比较治疗前、后NT-proBNP、h-FABP及超声心动参数的变化。结果:与对照组比较,OSA各亚组患者的h-FABP和NT-proBNP水平均显著升高(P<0.01),并与AHI呈正相关;OSA各组患者的Em/Am值和中、重度OSA组的E/A值均明显降低(P<0.01); Em/Am值各组之间差异有统计学意义(P<0.01);与治疗前对比,CPAP治疗后患者血清中的h-FABP和NT-proBNP水平均显著降低(P<0.01),Em/Am值和E/A值均明显增加(P<0.01)。结论:OSA患者早期心脏损伤以左室舒张功能损伤和心肌早期微损伤为主,CPAP治疗可显著改善OSA患者的早期心脏损伤。

Objective: To evaluate the early cardiac injury caused by obstructive sleep apnea( OSA) before the development of cardiovascular symptoms of OSA. Methods: Ninety-two patients without any known cardiovascular disorders who underwent polysomnography( PSG) were enrolled in the study. Subjects were divided into mild,moderate,and severe OSA groups by their apnea hypopnea index( AHI),and 25 healthy individuals were identified as controls. After PSG examination,fasting blood samples for the evaluation of N-terminal pro-brain natriuretic peptide( NT-proBNP) and heart-type fatty acid binding protein( h-FABP) were collected in the morning,and left ventricular( LV) functions were assessed by using echocardiographic methods. Thirty moderate and severe OSA patients were treated with continuous positive airway pressure respectively( CPAP).Results: The levels of h-FABP and NT-proBNP were obviously higher in all OSA groups than those in the control group( P<0.01),and were positively correlated with AHI( P<0.01). The Em/Am values of all OSA groups and E/A values of the moderate and severe OSA groups were significantly reduced( P< 0.01). The difference in Em/Am values among the groups was statistically significant( P<0.01). Compared with those before treatment,h-FABP and NT-BNP levels in serum of OSA patients after CPAP treatment were significantly reduced( P<0.01),and Em/Am and E/A values were significantly increased( P<0.01). Conclusion: Left ventricular diastolic dysfunction and early myocardial microtrauma are major manifestations of early heart damage in patients with OSA. CPAP therapy could significantly improve early cardiac damage in OSA patients.