围绝经期及绝经后妇女睡眠呼吸暂停低通气综合征与冠心病/心功能关系的研究

目的:探讨围绝经期及绝经后妇女阻塞性睡眠呼吸暂停低通气综合征(OSAS)与冠心病(CHD)及心功能的关系。方法:选取因发作性胸痛胸闷症状拟诊CHD入院的妇女39例,根据月经状况,分为围绝经期组16例,绝经后组23例。所有病例均经Embletta×30型便携式睡眠呼吸监测仪(扩展了心电监测功能)监测7h以上,均确诊为OSAS(2002杭州标准),并选择性冠状动脉造影(SCAG)确定CHD的诊断,检测血清雌二醇(E2)水平,及使用左.M右心导管法测定血流动力学参数,对比统计分析两组间E2、CHD危险因素、SCAG结果及血液动力学参数等改变。结果:①绝经后组的平均年龄、睡眠呼吸暂停低通气指数(AHI)及血胆固醇水平显著高于围绝经期组(P<0.01),E2显著低于后者(P<0.01);②绝经后组的SCAG阳性率(65.2%)显著高于围绝经期组(6.25%,P<0.01),而心律失常(房性及室性早搏)发生率在两组间无统计学差异(P=0.052)。③绝经后组的左.M右心室功能指标:左室射血分数(LVEF)显著低于围绝经期组(P<0.01),左室舒张末压(LVEDP)、右室舒张末压(RVEDP)及平均肺动脉压(mPAP)则显著高于后者(P<0.05)。结论:在女性OSAS患者中,年龄较大的绝经后妇女较年龄较轻的围绝经期妇女,呼吸紊乱程度更重,更易发生冠心病、左.M右心室收缩与舒张功能受损及肺动脉高压,其机制可能与绝经后妇女血清雌激素水平进一步降低有关。

Study on the relationship between obstructive sleep apnea syndrome and coronary heart disease in perimenopausal and postmenopausal women

Objective:To investigate the relationship between obstructive sleep apnea syndrome (OSAS) and coronary heart disease (CHD) in perimenopausal and postmenopausal women.Methods:39 female patients with suspected CHD admitted who had paroxysmal chest pain were recruited and divided into perimenopausal group (n=16) and postmenopausal group (n=23) according to menses.All of the patients was determined to have OSAS by polysomnogram (PSG), and was given selected coronary angiography (SCAG) and serum estradiol level examinations. The parameters of heart function were measured by standard 6Fr pigtail catheter.The mean ages, apnea hypopnea index (AHI), serum estradiol level, risk factors of CHD and left/right heart function parameters were statistically analysed to compare the parameters of left/right heart function involved in left ventricular ejection fraction (LVEF), left ventricular end diastolic pressure (LVEDP), right ventricular end diastolic pressure and mean pulmonary artery pressure (mPAP).Results:① Mean ages, AHI and blood cholesterol level in postmenopausal group were higher than those in perimenopausal group (P<0.01), and serum estradiol level in postmenopausal group was lower than that in perimenopausal group (P<0.01).② Abnormal SCAG in postmenopausal group (65.2%) was higher than that in perimenopausal group (6.25%, P<0.01).Atrial and ventricular arrhythmia (premature beat) had no significance between the two groups (P=0.052).③ LVEF value in postmenopausal group was lower than that in perimenopausal group (P<0.01).Values of LVEDP, RVEDP and mPAP in postmenopausal group were higher than those in perimenopausal group (P<0.05).Conclusion:In female patients with OSAS, the aged postmenopausal women have more severe respiratory disorders, and are more likely to have CHD, damaged systolic and diastolic function of left/right ventricle and pulmonary hypertension than younger perimenopausal women.The mechanisms maybe relate to lower level of serum estrogen in the aged postmenopausal women than in perimenopausal women.