nCPAP通气对阻塞性睡眠呼吸暂停低通气综合征合并冠心病内皮功能的影响

目的探讨经鼻持续气道正压（nCPAP）通气对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并冠心病内皮功能的影响。方法选OSAHS（OSAHS组）、冠心病（冠心病组）、OSAHS合并冠心病（OSAHS合并冠心病组）及对照（对照组）者各20例,行多导睡眠图监测,计算平均脉搏血氧饱和度（MSpO2）、SpO2≤90％的累积时间占总睡眠时间百分比（C190）;对OSAHS、OSAHS合并冠心病者行nCPAP通气治疗,观察MSpO2、CT90的变化。测4组受试者血清NO、血浆内皮素-1（ET-1）水平。结果（1）logistic回归分析显示,OSAHS是冠心病发生的重要原因之一。（2）与对照组和冠心病组相比,OSAHS组、OSAHS合并冠心病组CT90、ET-1升高,MSpO2、NO下降,差异有统计学意义（P〈0．01）。OSAHS合并冠心病组与OSAHS组相比,C190、MSpO2差异无统计学意义（P〉0．05）;但ET-1高于后者,NO低于后者,差异有统计学意义（P〈0．01）。（3）OSAHS组NO水平与MSpO2呈正相关,与CT90呈负相关;ET-1水平与MSpO2呈负相关,与C190呈正相关。（4）nCPAP通气治疗后,OSAHS组、OSAHS合并冠心病组MSpO2、NO较治疗前均升高,C190、ET-1均降低（P〈0．01）。结论OSAHS是冠心病的重要危险因素之一。OSAHS可引起内皮功能不全,OSAHS合并冠心病时内皮功能损害更显著,血管内皮功能的损害可能是OSAHS形成或加重冠心病的机制之一。nCPAP通气治疗可改善OSAHS患者血管内皮功能,与夜间低氧血症的改善相关。

The effect of nasal continuous positive airway pressure on endothelial function in obstructive sleep apnea-hypopnea syndrome with coronary heart disease

ObjectiveTo study the association between the indices of endothelial function in obstruction sleep apnea-hypopnea syndrome (OSAHS) and coronary heart disease (CHD) and the effect of nasal continuous positive airway pressure(nCPAP) on the combination of OSAHS and CHD. MethodsA total of 80 subjects were prospectively recruited into four groups including control, OSAHS, CHD, OSAHS with CHD groups, with 20 subjects each.The indices of sleep apnea, serum nitric oxide (NO), and plasma endothelial-1 (ET-1) were measured. The changes of concentration of ET-1 and NO were compared before and after nCPAP therapy. The associations between ET-1 and NO and MSpO_2, CT90 were analyzed. Results (1)Multi-variable logistic analysis showed that OSAHS was one of the risk factors for CHD (OR=0.511). (2) Compared with the control subjects and CHD group, there were significantly higher values of CT90, concentrations of ET-1 and lower values of MSpO_2, concentrations of NO in both OSAHS and OSAHS with CHD groups (P<0.01). There were no significant difference in sleep apnea indices between OSAHS and OSAHS with CHD groups(P>0.05). However, in the group of OSAHS with CHD, the plasma ET-1 was significantly higher, whereas the serum NO was significantly lower than that in the group of OSAHS alone (P<0.01) . (3) The concentration of serum NO in the group of OSAHS was positively correlated with MSpO_2 (r=0.519, P<0.05) and inversely correlated with CT90 (r=-0.529, P<0.05). In addition, the concentration of plasma ET-1 was inversely correlated with MSpO_2(r=-0.457,P<0.05) and positively correlated with CT90 (r=0.476, P<0.05). (4) In the groups of OSAHS and OSAHS with CHD, MSpO_2, NO and NO/ET-1 after nCPAP therapy were higher than those before therapy, while CT90 and ET-1 were lower than those before therapy (P<0.01). ConclusionsOSAHS is one of the risk factors for CHD. Endothelial function was significantly impaired in OSAHS patients, and more severe in patients with OSAHS with CHD. The impairment of endothelial function may be one of the main mechanisms for the development or deterioration of CHD in OSAHS patients. The vascular endothelial dysfunction can be ameliorated by nCPAP treatment, which is correlated with improvement of nocturnal hypoxemia.