冠心病患者中睡眠呼吸暂停综合征的监测及其临床意义

目的:观察冠心病(CHD)患者中阻塞性睡眠呼吸暂停综合征(OSAS)的患病率,探讨OSAS与CHD的关系.方法:83例可疑CHD的患者行冠状动脉造影,依据造影结果分为CHD组(48例),冠状动脉造影阴性组(35例), 83例患者均行多导睡眠仪(PSG)监测,依据PSG监测得出的睡眠呼吸暂停低通气指数(AHI)分为轻度OSAS组(10≤AHI<20, 23例)、中重度OSAS组(AHI≥20,21例)和非OSAS组(对照组,AHI<10, 39例).3组均计算Gensini评分,用于评估冠状动脉粥样硬化病变的程度.用Logistic回归评估OSAS以及其他危险对CHD的影响.结果:CHD组中OSAS的患病率高于冠状动脉造影阴性组.轻度和中重度OSAS组,最低血氧饱和度低于对照组;CHD患病率高于对照组;冠状动脉病变单支受累百分率显著高于对照组,多支受累百分率高于对照组;中重度OSAS组的Gensini评分显著高于对照组.多因素Logistic回归得出OSAS、高血压以及脂蛋白(a)与CHD独立相关.结论:在冠状动脉造影证实的CHD患者中OSAS患病率较高,多因素回归发现OSAS与CHD独立相关,OSAS可能是导致冠心病的一个重要的独立危险因素.

Clinic significance of monitoring obstructive sleep apnea syndrome among the patients with coronary artery disease

Objective:The aim of our study was to assess the prevalence of obstructive sleep apnea syndrome(OSAS) in patients with chest pain and angiographically verified coronary artery disease(CHD).Additionally we analyzed the association of OSAS and coronary risk factors with CHD.Method:83 consecutive selection patients were classified into two groups according to the coronary angiography(CAG) results: CHD group(48 patients with verified CHD);normal group(35 patients with exclusion of CHD).Overnight polysomography(PSG)recordings for detection of OSAS was performed in 83 patients. They were divided into three groups based on their nocturnal apnea hypopnea index (AHI) detected by examination of polysomnography(PSG),mild OSAS group(10≤AHI<20,23 cases),moderate-to-severe group(AHI≥20,21 cases)and control group (AHI<10,39cases). Gensini Score for assessing the severity of coronary atherosclerosis were made in all three groups.Mutiple logistic regression analysis was performed to assess OSAS and other coronary risk factors with CHD.Results:CHD patients were found to have higher morbidity rate of OSAS than that in normal subjects.Compared with the control group,AHI was significantly higher in OSAS groups. The minimal Sp02 were significantly lower in OSAS groups than that in the control group.The incidence of CHD was significantly higher in OSAS groups than that in the control group.The percentage of patients with single-coronary-vessel disease was higher in OSAS group than in control group.The patients with multi-coronary-vessel disease were higher in OSAS group than that in control group.Gensini Score was significantly higher in moderate-to-severe OSAS group than that in control group.OSAS、hypertension and LP(a) were independently associated with CHD.Conclution:There is a high occurrence of OSAS in patients with angiographically verified CHD.OSAS is independently associated with CHD.OSAS might be a significant independent risk factor of coronary atherosclerosis.