OBJECTIVE Obstructive sleep apnea(OSA)is a potential cardiovascular risk.We aimed to investigate the association of OSA with heart rhythm disorders and prognosis in elderly patients with new-onset acute myocardial inf...OBJECTIVE Obstructive sleep apnea(OSA)is a potential cardiovascular risk.We aimed to investigate the association of OSA with heart rhythm disorders and prognosis in elderly patients with new-onset acute myocardial infarction(AMI).METHODS We prospectively enrolled 252 AMI elderly patients(mean age,68.5±6.9 years)who were undergoing revascularization and completed a sleep study during their hospitalization.All subjects were categorized into non-OSA(apnea–hypopnea index(AHI)<15,n=130)and OSA(AHI≥15,n=122)groups based on the AHI.The changes in the autonomic nervous system,incidence of arrhythmia during nocturnal sleep,and major adverse cardiovascular and cerebrovascular events(MACCEs)were compared between the groups.RESULTS The mean AHI value in all AMI patients was 22.8±10.9.OSA patients showed higher levels of body mass index and peak high-sensitivity C-reactive protein and lower levels of minimum nocturnal oxygen saturation(Min Sa O2),as well as greater proportion of multivessel coronary artery disease(all P<0.05).The OSA group also showed significant increases in heart rate variability and heart rate turbulence onset(both P<0.05)and higher incidence of arrhythmia(including sinus,atrial,and ventricular in origin).At a median follow-up of 6 months(mean 0.8–1.6 years),OSA(AHI≥15)combined with hypoxia(Min Sa O2≤80%)was independently associated with the incidence of MACCEs(hazard ratio[HR]:4.536;95%confidence interval[CI]:1.461-14.084,P=0.009)after adjusting for traditional risk factors.CONCLUSIONS OSA and OSA-induced hypoxia may correlate with the severity of myocardial infarction,increase the occurrence of heart rhythm disorders in elderly subacute MI patients,and worsen their short-term poor outcomes.展开更多
To investigate the possible correlation between obstructive sleep apnea(OSA) and central retinal vein occlusion(CRVO). Thirty consecutive patients with a recent(<3 mo)CRVO and an age-and sex-matched group of 30 con...To investigate the possible correlation between obstructive sleep apnea(OSA) and central retinal vein occlusion(CRVO). Thirty consecutive patients with a recent(<3 mo)CRVO and an age-and sex-matched group of 30 control subjects were recruited. All subjects underwent full-night polysomnography to measure apnea-hypopnea index(AHI)and oxygen desaturation index(ODI). The average AHI and ODI were significantly higher in CRVO patients(AHI:13.86±8.63, ODI: 9.21±4.47) than in control subjects(AHI:8.51±6.36, ODI: 5.87±3.18;P=0.008 and 0.001 respectively).Additionally, the AHI was positively correlated with body mass index(BMI;r=0.476, P=0.017) and ODI(r=0.921,P<0.01) in both CRVO and control subjects. According to AHI scores, twenty-two(73.33%) CRVO patients had OSA and 12(40.00%) control subjects had OSA, a difference that was statistically significant(P=0.019). OSA may be a risk factor for or a trigger of CRVO development.展开更多
Heart failure (HF) is known to be associated with sleep-disordered breathing(SDB). In addition to disturbing patients’ sleep, SDB is also associated with a deterioration in the cardiac function and an increased morta...Heart failure (HF) is known to be associated with sleep-disordered breathing(SDB). In addition to disturbing patients’ sleep, SDB is also associated with a deterioration in the cardiac function and an increased mortality and morbidity.Central sleep apnea (CSA), typically characterized by Cheyne-Stokes breathing(CSB), is increasingly found in patients with HF compared to the general population. An important pathogenetic factor of CSA seen in HF patients is an instability in the control of the respiratory system, characterized by both hypocapnia and increased chemosensitivity. Sympathetic overactivation,pulmonary congestion and increased chemosensitivity associated with HF stimulate the pulmonary vagal irritant receptor, resulting in chronic hyperventilation and hypocapnia. Additionally, the repetitive apnea and arousal cycles induce cyclic sympathetic activation, which may worsen the cardiac prognosis. Correcting CSB may improve both patient’s quality of life and HF syndrome itself. However, a treatment for HF in patients also experiencing CSA is yet to be found. In fact, conflicting results from numerous clinical studies investigating sleep apnea with HF guide to a troubling question, that is whether(or not) sleep apnea should be treated in patients with HF? This editorial attempts to both collect the current evidence about randomized control trials investigating CSA in patients with HF and highlight the effect of specific CSA treatments on cardiovascular endpoints.展开更多
Objective To assess the incidence and predictors of heart rhythm and conduction disturbances in hypertensive obese patients with andwithout obstructive sleep apnea （OSA）. Methods This is an open, cohort, prospective...Objective To assess the incidence and predictors of heart rhythm and conduction disturbances in hypertensive obese patients with andwithout obstructive sleep apnea （OSA）. Methods This is an open, cohort, prospective study. Out of 493 screened patients, we selected 279hypertensive, obese individuals without severe concomitant diseases： 75 patients without sleep-disordered breathing （non-SDB group）, and204 patients with OSA （OSA group）. At baseline, all patients underwent examination, including ECG, Holter ECG monitoring, and sleepstudy. During follow-up （on 3, 5, 7 and 10th years; phone calls once per 6 months）, information about new events, changes in therapy and lifestyle was collected, diagnostic procedures were performed. As the endpoints, we registered significant heart rhythm and conduction disordersas following： atrial fibrillation （AF）, ventricular tachycardia, atrioventricular block （AV） 2-3 degree, sinoatrial block, significant sinus pauses（〉 2000 ms）, and the required pacemaker implantation. Results The median follow-up was 108 （67.5-120） months. The frequency of heartrhythm disorders was higher in OSA patients （29 cases, X^2= 5.5; P = 0.019） compared to the non-SDB patients （three cases; OR： 3.92, 95%CI： 1.16-13.29）. AF was registered in 15 patients （n = 12 in OSA group; P = 0.77）. Heart conduction disturbance developed in 16 patients,without an association with the rate of coronary artery disease onset. Regression analysis showed that only hypertension duration was anindependent predictor olAF （OR： 1.10, 95% CI： 1.04-1.16; P = 0.001）. In case of heart conduction disturbances, apnea duration was thestrongest predictor （P = 0.002）. Conclusions Hypertensive obese patients with OSA demonstrate 4-fold higher incidence of heart rhythmand conduction disturbances than subjects without SDB. Hypertension duration is an independent predictor for AF development, while sleepapneaJhypopnea duration is the main factor for heart conduction disorders onset in hypertensive obese patients with OSA.展开更多
Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder. It has been reported that approximately 40% of patients with moderate or severe OSAS die within the first eight years of disease. In hospitals, OSAS ...Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder. It has been reported that approximately 40% of patients with moderate or severe OSAS die within the first eight years of disease. In hospitals, OSAS is inspected using polysomnography, which uses a number of sensors. Because of the cumbersome nature of this polysomnography, an initial OSAS screening is usually conducted. In recent years, OSAS screening techniques using Holter electrocardiogram (ECG) have been reported. However, the techniques so far reported cannot perform an OSAS severity assessment. The present study presents a new method to distinguish the obstructive sleep apnea (OSA) and non-OSA epochs at one-second intervals based on the Apnea Hypopnea Index assessment, defined as the duration of continuous apnea. In the proposed method, the time-frequency components of the heart rate variability and three ECG-derived respiration signals calculated by the complex Morlet wavelet transformation are adopted as features. A support vector machine is employed for classification. The proposed method is evaluated using three eight-hour ECG recordings containing OSA episodes from three subjects. As a result, the sensitivity and specificity of classification are found to reach approximately 90%, a level suitable for OSAS screening in clinical settings.展开更多
Obstructive Sleep Apnea(OSA)is a common chronic disorder that affects 5–10%of the US population with a higher prevalence in men compared to women by 2:1 in population studies.By contrast,in patients with cardiovascul...Obstructive Sleep Apnea(OSA)is a common chronic disorder that affects 5–10%of the US population with a higher prevalence in men compared to women by 2:1 in population studies.By contrast,in patients with cardiovascular disease,its prevalence can exceed 50%depending on the specifi c disorder surveyed.Although sex differences have been well described for cardiovascular risk factors;existing data regarding the impact of sex on the relationship between OSA and cardiovascular outcomes is controversial.Similarly,while there is strong evidence for increased prevalence of cardiovascular conditions,such as systemic hypertension,atrial fibrillation,as well as heart failure amongst patients suffering from OSA;confl icting evidence exists regarding the incidence and bidirectional relationship between them as well as the impact of treatment of OSA on cardiovascular outcomes.In this paper,we will review the associations between OSA and cardiovascular diseases in women.The data on sex differences is limited,due to a number of reasons,including,but not limited to late presentation of OSA in women,diffi culties in diagnosing both OSA and cardiovascular diseases in women and still suboptimal inclusion of adequate number of women in clinical trials.More studies are needed to better delineate sex differences in the clinical presentation as well as the pathophysiology of the associations between OSA and cardiovascular diseases so that we can provide patients with more personalized care.展开更多
目的探讨肥胖合并重度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者的心率变异性(heart rate variability,HRV)特征。方法回顾性分析2018年4月至2022年5月在西安交通大学第二附属医院行多导睡...目的探讨肥胖合并重度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者的心率变异性(heart rate variability,HRV)特征。方法回顾性分析2018年4月至2022年5月在西安交通大学第二附属医院行多导睡眠(polysomnography,PSG)监测确诊为重度OSAHS的78例患者,根据身体质量(body mass index,BMI)将患者分为肥胖并重度OSAHS组(n=43)和非肥胖并重度OSAHS组(n=35)。所有患者行PSG监测同时接受24 h动态心电图监测,进行HRV指标的组间差异分析及与临床指标的相关性分析。结果基础指标及PSG指标分析结果显示,与非肥胖并重度OSAHS组相比,肥胖并重度OSAHS组体质量、BMI、颈围、腰围、呼吸暂停低通气指数(apnea hypopnea index,AHI)显著升高。组间HRV分析结果显示,与非肥胖并重度OSAHS组相比,肥胖并重度OSAHS组的24 h正常R-R间期标准差(standard deviation of R-R interval,SDNN)、5 min R-R间期均值标准差(standard deviation of the averages of 5-minute R-R intervals,SDANN)、三角指数(triangle index,TI)、心率减速力(deceleration capacity of heart rate,DC)、清醒期SDNN及睡眠高频功率明显降低(P<0.05)。相关性结果显示肥胖并重度OSAHS患者中相邻R-R间期差值均方根(root mean square of the difference of adjacent R-R interval,rMSSD)与高血压病程呈负相关,TI、DC与AHI呈负相关。经校正颈围和腰围后的线性回归分析显示SDNN、SDANN、rMSSD与收缩压相关(P<0.05)。结论肥胖并重度OSAHS患者存在HRV指标下降,自主神经功能受到损害,心血管疾病的发生风险增加。展开更多
基金supported by National Natural Science Youth Fund of China(81100098)Shanghai Municipal Commission of Health and Family Planning for Key Discipline Establishment(2015ZB0503&201840083)Production,Teaching and Research Program for University Teachers in Shanghai(RC20190079)。
文摘OBJECTIVE Obstructive sleep apnea(OSA)is a potential cardiovascular risk.We aimed to investigate the association of OSA with heart rhythm disorders and prognosis in elderly patients with new-onset acute myocardial infarction(AMI).METHODS We prospectively enrolled 252 AMI elderly patients(mean age,68.5±6.9 years)who were undergoing revascularization and completed a sleep study during their hospitalization.All subjects were categorized into non-OSA(apnea–hypopnea index(AHI)<15,n=130)and OSA(AHI≥15,n=122)groups based on the AHI.The changes in the autonomic nervous system,incidence of arrhythmia during nocturnal sleep,and major adverse cardiovascular and cerebrovascular events(MACCEs)were compared between the groups.RESULTS The mean AHI value in all AMI patients was 22.8±10.9.OSA patients showed higher levels of body mass index and peak high-sensitivity C-reactive protein and lower levels of minimum nocturnal oxygen saturation(Min Sa O2),as well as greater proportion of multivessel coronary artery disease(all P<0.05).The OSA group also showed significant increases in heart rate variability and heart rate turbulence onset(both P<0.05)and higher incidence of arrhythmia(including sinus,atrial,and ventricular in origin).At a median follow-up of 6 months(mean 0.8–1.6 years),OSA(AHI≥15)combined with hypoxia(Min Sa O2≤80%)was independently associated with the incidence of MACCEs(hazard ratio[HR]:4.536;95%confidence interval[CI]:1.461-14.084,P=0.009)after adjusting for traditional risk factors.CONCLUSIONS OSA and OSA-induced hypoxia may correlate with the severity of myocardial infarction,increase the occurrence of heart rhythm disorders in elderly subacute MI patients,and worsen their short-term poor outcomes.
基金Supported by Planned Science and Technology Project of Xi’an City, China [No.2017116SF/YX010(9)]
文摘To investigate the possible correlation between obstructive sleep apnea(OSA) and central retinal vein occlusion(CRVO). Thirty consecutive patients with a recent(<3 mo)CRVO and an age-and sex-matched group of 30 control subjects were recruited. All subjects underwent full-night polysomnography to measure apnea-hypopnea index(AHI)and oxygen desaturation index(ODI). The average AHI and ODI were significantly higher in CRVO patients(AHI:13.86±8.63, ODI: 9.21±4.47) than in control subjects(AHI:8.51±6.36, ODI: 5.87±3.18;P=0.008 and 0.001 respectively).Additionally, the AHI was positively correlated with body mass index(BMI;r=0.476, P=0.017) and ODI(r=0.921,P<0.01) in both CRVO and control subjects. According to AHI scores, twenty-two(73.33%) CRVO patients had OSA and 12(40.00%) control subjects had OSA, a difference that was statistically significant(P=0.019). OSA may be a risk factor for or a trigger of CRVO development.
文摘Heart failure (HF) is known to be associated with sleep-disordered breathing(SDB). In addition to disturbing patients’ sleep, SDB is also associated with a deterioration in the cardiac function and an increased mortality and morbidity.Central sleep apnea (CSA), typically characterized by Cheyne-Stokes breathing(CSB), is increasingly found in patients with HF compared to the general population. An important pathogenetic factor of CSA seen in HF patients is an instability in the control of the respiratory system, characterized by both hypocapnia and increased chemosensitivity. Sympathetic overactivation,pulmonary congestion and increased chemosensitivity associated with HF stimulate the pulmonary vagal irritant receptor, resulting in chronic hyperventilation and hypocapnia. Additionally, the repetitive apnea and arousal cycles induce cyclic sympathetic activation, which may worsen the cardiac prognosis. Correcting CSB may improve both patient’s quality of life and HF syndrome itself. However, a treatment for HF in patients also experiencing CSA is yet to be found. In fact, conflicting results from numerous clinical studies investigating sleep apnea with HF guide to a troubling question, that is whether(or not) sleep apnea should be treated in patients with HF? This editorial attempts to both collect the current evidence about randomized control trials investigating CSA in patients with HF and highlight the effect of specific CSA treatments on cardiovascular endpoints.
文摘Objective To assess the incidence and predictors of heart rhythm and conduction disturbances in hypertensive obese patients with andwithout obstructive sleep apnea （OSA）. Methods This is an open, cohort, prospective study. Out of 493 screened patients, we selected 279hypertensive, obese individuals without severe concomitant diseases： 75 patients without sleep-disordered breathing （non-SDB group）, and204 patients with OSA （OSA group）. At baseline, all patients underwent examination, including ECG, Holter ECG monitoring, and sleepstudy. During follow-up （on 3, 5, 7 and 10th years; phone calls once per 6 months）, information about new events, changes in therapy and lifestyle was collected, diagnostic procedures were performed. As the endpoints, we registered significant heart rhythm and conduction disordersas following： atrial fibrillation （AF）, ventricular tachycardia, atrioventricular block （AV） 2-3 degree, sinoatrial block, significant sinus pauses（〉 2000 ms）, and the required pacemaker implantation. Results The median follow-up was 108 （67.5-120） months. The frequency of heartrhythm disorders was higher in OSA patients （29 cases, X^2= 5.5; P = 0.019） compared to the non-SDB patients （three cases; OR： 3.92, 95%CI： 1.16-13.29）. AF was registered in 15 patients （n = 12 in OSA group; P = 0.77）. Heart conduction disturbance developed in 16 patients,without an association with the rate of coronary artery disease onset. Regression analysis showed that only hypertension duration was anindependent predictor olAF （OR： 1.10, 95% CI： 1.04-1.16; P = 0.001）. In case of heart conduction disturbances, apnea duration was thestrongest predictor （P = 0.002）. Conclusions Hypertensive obese patients with OSA demonstrate 4-fold higher incidence of heart rhythmand conduction disturbances than subjects without SDB. Hypertension duration is an independent predictor for AF development, while sleepapneaJhypopnea duration is the main factor for heart conduction disorders onset in hypertensive obese patients with OSA.
文摘Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder. It has been reported that approximately 40% of patients with moderate or severe OSAS die within the first eight years of disease. In hospitals, OSAS is inspected using polysomnography, which uses a number of sensors. Because of the cumbersome nature of this polysomnography, an initial OSAS screening is usually conducted. In recent years, OSAS screening techniques using Holter electrocardiogram (ECG) have been reported. However, the techniques so far reported cannot perform an OSAS severity assessment. The present study presents a new method to distinguish the obstructive sleep apnea (OSA) and non-OSA epochs at one-second intervals based on the Apnea Hypopnea Index assessment, defined as the duration of continuous apnea. In the proposed method, the time-frequency components of the heart rate variability and three ECG-derived respiration signals calculated by the complex Morlet wavelet transformation are adopted as features. A support vector machine is employed for classification. The proposed method is evaluated using three eight-hour ECG recordings containing OSA episodes from three subjects. As a result, the sensitivity and specificity of classification are found to reach approximately 90%, a level suitable for OSAS screening in clinical settings.
文摘Obstructive Sleep Apnea(OSA)is a common chronic disorder that affects 5–10%of the US population with a higher prevalence in men compared to women by 2:1 in population studies.By contrast,in patients with cardiovascular disease,its prevalence can exceed 50%depending on the specifi c disorder surveyed.Although sex differences have been well described for cardiovascular risk factors;existing data regarding the impact of sex on the relationship between OSA and cardiovascular outcomes is controversial.Similarly,while there is strong evidence for increased prevalence of cardiovascular conditions,such as systemic hypertension,atrial fibrillation,as well as heart failure amongst patients suffering from OSA;confl icting evidence exists regarding the incidence and bidirectional relationship between them as well as the impact of treatment of OSA on cardiovascular outcomes.In this paper,we will review the associations between OSA and cardiovascular diseases in women.The data on sex differences is limited,due to a number of reasons,including,but not limited to late presentation of OSA in women,diffi culties in diagnosing both OSA and cardiovascular diseases in women and still suboptimal inclusion of adequate number of women in clinical trials.More studies are needed to better delineate sex differences in the clinical presentation as well as the pathophysiology of the associations between OSA and cardiovascular diseases so that we can provide patients with more personalized care.
文摘目的探讨肥胖合并重度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者的心率变异性(heart rate variability,HRV)特征。方法回顾性分析2018年4月至2022年5月在西安交通大学第二附属医院行多导睡眠(polysomnography,PSG)监测确诊为重度OSAHS的78例患者,根据身体质量(body mass index,BMI)将患者分为肥胖并重度OSAHS组(n=43)和非肥胖并重度OSAHS组(n=35)。所有患者行PSG监测同时接受24 h动态心电图监测,进行HRV指标的组间差异分析及与临床指标的相关性分析。结果基础指标及PSG指标分析结果显示,与非肥胖并重度OSAHS组相比,肥胖并重度OSAHS组体质量、BMI、颈围、腰围、呼吸暂停低通气指数(apnea hypopnea index,AHI)显著升高。组间HRV分析结果显示,与非肥胖并重度OSAHS组相比,肥胖并重度OSAHS组的24 h正常R-R间期标准差(standard deviation of R-R interval,SDNN)、5 min R-R间期均值标准差(standard deviation of the averages of 5-minute R-R intervals,SDANN)、三角指数(triangle index,TI)、心率减速力(deceleration capacity of heart rate,DC)、清醒期SDNN及睡眠高频功率明显降低(P<0.05)。相关性结果显示肥胖并重度OSAHS患者中相邻R-R间期差值均方根(root mean square of the difference of adjacent R-R interval,rMSSD)与高血压病程呈负相关,TI、DC与AHI呈负相关。经校正颈围和腰围后的线性回归分析显示SDNN、SDANN、rMSSD与收缩压相关(P<0.05)。结论肥胖并重度OSAHS患者存在HRV指标下降,自主神经功能受到损害,心血管疾病的发生风险增加。
