阻塞性呼吸睡眠暂停综合征对急性冠脉综合征严重程度与长期预后影响研究

发布时间：2018-04-13 09:32

  本文选题：阻塞性睡眠呼吸暂停 + 冠心病　； 参考：《首都医科大学》2017年博士论文

【摘要】：目的:阻塞性睡眠呼吸暂停(Obstructive sleep apnea,OSA)是一种临床常见的睡眠障碍类疾病,已有研究支持睡眠呼吸暂停与冠心病之间存在密切关系。但目前关于OSA与急性冠脉综合征(acute coronary syndrome,ACS)患者相关研究较少。本研究旨在评估阻塞性睡眠呼吸暂停对接受经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)后ACS患者的病变严重程度(如射血分数、SYNTAX评分、住院时间等)和长期预后(主要不良心血管事件Major Adverse Cardiovascular Events,MACE)的影响。方法:本研究为单中心前瞻性队列研究,选择2012年12月至2015年12月于首都医科大学附属北京安贞医院心内科住院并行冠状动脉介入治疗的患者,严格按照入排标准最终共纳入患者579例。所有患者均行冠脉造影检查和/或冠脉介入治疗及多导睡眠图(Polysomnography,PSG)检查,根据睡眠呼吸监测结果将睡眠呼吸暂停低通气指数(apnea-hypopnea index,AHI)≤15次/小时作为对照组,AHI15次/小时为中重度OSA组。比较两组患者ACS严重程度(疾病诊断分型、SYNTAX评分、射血分数以及住院时间),对两组患者进行随访并记录MACE事件(心源性死亡、非致命性心肌梗死、靶血管再次血运重建、再次发作心绞痛、因心衰发作住院治疗)比较长期预后差异。结果:最终进行随访并纳入分析529名患者(50例失访),156例患者AHI≤15次/小时,373例患者AHI15次/小时。中重度OSA患者组评价AHI为37.2±16.9,而对照组为9.4±3.4。与对照组相比,中重度OSA组男性患者所占比例(79.9%vs 69.2%,P=0.008)和高血压患病率较高(75.3%vs 64.1%,P=0.009),同时合并有较高的体重指数(BMI)(28.1±3.6 vs 26.4±3.4,P0.001)和Epworth评分(6.2±5.4 vs 4.5±3.9,P0.001)。中重度OSA组多支血管病变患者的比例(28.2%vs 10.3%,P0.001)、SYNTAX评分(10.1±10.0 vs 3.0±6.4,P0.001)和住院天数(8.0±5.6 vs 6.7±4.2,P=0.007)较高,同时合并较低的射血分数(61.8±8.3 vs 63.8±6.8,P=0.009)。中位随访时间为28±4.6个月,中重度OSA组事件发生率显著高于对照组(8.6%vs 3.2%,P=0.028)。在矫正了年龄、性别等混杂因素后显示中重度OSA组发生不良事件的风险增加(HR=2.758,95%CI1.068-7.122,P=0.036)。结论:中重度OSA组患者ACS严重程度更高,常合并更加复杂的冠状动脉病变,对ACS患者PCI术后长期事件发生率有不良的影响,中重度OSA是不良心血管事件发生的独立危险因素。
[Abstract]:Objective: obstructive sleep apnea (OSA) is one of the most common sleep disorders, and has been studied to support the close relationship between sleep apnea and coronary heart disease.However, there are few studies on the relationship between OSA and acute coronary syndrome (ACS).The purpose of this study was to evaluate the severity of obstructive sleep apnea (OSAS) in patients with ACS after percutaneous coronary intervention (PCI), such as ejection fraction (EPS).Duration of hospitalization and long-term prognosis (major adverse cardiovascular events Major Adverse Cardiovascular events).Methods: this study was a single center prospective cohort study. Patients admitted to Beijing Anzhen Hospital from December 2012 to December 2015 with coronary intervention were enrolled in the study.A total of 579 patients were included according to the admission criteria.All patients underwent coronary angiography and / or coronary intervention and polysomnography (PSG).According to the results of sleep respiration monitoring, the apnea hypopnea index (apnea-hypopnea index) 鈮，

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