持续气道正压通气治疗对OSA合并冠心病的长期预后影响的研究

王金凤; 方金瑞; 谢宇平; 马薇; 惠培林; 苏晓艳; 郭斌; 刘瑜

doi:10.13201/j.issn.1001-1781.2019.11.006

持续气道正压通气治疗对OSA合并冠心病的长期预后影响的研究

- 1. 甘肃省人民医院睡眠医学中心(兰州, 730000);
- 2. 甘肃省人民医院日间诊疗中心
基金项目:
国家自然科学基金(No:81560228)

2018甘肃省卫生和计划生育委员会项目(No:1291)

2018年甘肃省人民医院院内基金项目(No:18GSSY4-19)

2016年甘肃省卫生行业科研计划项目(No:GSWSKY2016-07)

2015年甘肃省重大疾病调查研究项目(No:2015-01)

2019年甘肃省卫生行业科研管理项目(CPAP对OSA合并冠心病的冠脉病变及长期预后影响的研究)

详细信息

通讯作者: 谢宇平,E-mail:xyp5894@163.com

中图分类号: R563.8

收稿日期: 2019-03-18

Research on the effects of CPAP for OSA combined CHD long-term prognosis

- 1 Sleep Medicine Center, Gansu Provincial People Hospital, Lanzhou, 730000, China;
- 2 Day care center, Gansu Provincial People Hospital

More Information

Corresponding author: XIE Yuping, E-mail: xyp5894@163.com

Received Date: 18 March 2019

摘要

摘要: 目的:探讨持续气道正压通气治疗(CPAP)对OSA合并冠心病(CHD)长期预后影响的研究。方法:随机选取OSA合并CHD患者120例,依据AHI分为2组,A组(轻、中度OSA合并CHD)60例、B组(重度OSA组合并CHD)60例。对比分析各组PSG参数及冠脉病变程度的差异及CPAP治疗后对冠脉长期预后的影响。结果:B组较A组,AHI、BMI、低血氧饱和度(LSaO₂),ESS评分,同型半胱氨酸氨酸,高血压、2型糖尿病的患病率,急性心梗、多血管病变的患病率及SYNTAX评分显著增加(P<0.05);射血分数显著降低(P<0.05);BNP及cTNT浓度2组差异无统计学意义(P>0.05)。随访(30.0±4.2)个月后,B组:CAPA+常规治疗组较单纯常规治疗组,LSaO₂、射血分数显著增加(P<0.05),AHI、心血管不良事件、多血管病变、SYNTAX评分、BNP及TNT浓度显著降低(P<0.05);A组:AHI显著降低(P<0.05),LSaO₂显著增加(P<0.05),射血分数、心血管不良事件、多血管病变、SYNTAX评分、BNP及TNT浓度无显著性差异;生存分析显示,A组:CPAP+常规治疗组累计生存率高于常规治疗组,但差异无统计学意义(P=0.260);B组:CPAP+常规治疗组累计生存率显著高于常规治疗组(P<0.001)。结论:随着OSA严重程度的增加,OSA合并CHD的冠脉病变程度进一步加重;CPAP治疗有利于CHD的长期预后。
- 睡眠呼吸暂停低通气综合征 /
- 阻塞性 /
- 冠心病 /
- 持续气道正压通气治疗
Abstract: Objective: To investigate the effects of CPAP for obstructive sleep apnea(OSA) combined CHD(coronary heart disease) long-term prognosis. Method: One hundred and twenty cases of OSA combind CHD in gansu province people's hospital sleep center were randomly divided into two groups according to apnea hypopnea index(AHI), group A(light, medium OSA and CHD) 60 cases, group B(severe OSA and CHD) 60 cases. Contrast analysis and comparison between two groups PSG(Polysomnography) parameters, and the differences between the degree of coronary artery lesions and CPAP therapy effect on coronary long-term prognosis. Result: Compared group B with A, AHI, BMI, LSaO₂, Epworth sleepiness scale(ESS) score, the amino acid homocysteine, the prevalence of hypertension, type 2 diabetes, the prevalence of acute myocardial infarction(ami) and vascular lesions and SYNTAX score increased significantly(P<0.05). The ejection fraction decreased significantly(P<0.05). The BNP(Brain natriuretic peptide) and cTNT(cardiac troponin, cTn) concentration there was no significant difference between the two groups(P>0.05). CPAP treatment(30.0±4.2) months later, Group B: CAPA + conventional treatment group, compared with the simple routine LSaO₂, ejection fraction increased significantly(P<0.05), AHI, cardiovascular adverse events, vascular lesions, SYNTAX score, the BNP and TNT concentration significantly reduced(P<0.05); Group A: AHI, decreased significantly(P<0.05), LSaO₂increased significantly(P<0.05), ejection fraction, cardiovascular adverse events, vascular lesions, SYNTAX score, there was no significant difference between the BNP and TNT concentration; Survival analysis showed that: Group A CPAP+conventional treatment group cumulative survival rate higher than the conventional treatment group, but there was no statistically significant difference(P=0.260). Group B: CPAP+conventional treatment group total survival rate was significantly higher than that of the conventional treatment group(P<0.001);Conclusion: With the increase of the severity of OSA, OSA merge CHD coronary artery pathological changes degree aggravating, CPAP therapeutic benefit the long-term prognosis of CHD.
- obstructive sleep apnea syndrom /
- coronary heart disease /
- continuous positive airway pressure /

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参考文献(20)

[1]	PERGER E,GONZAGA-CARVALHO C,INAMI T,et al.Obstructive Sleep Apnea and Cardiovascular Disease[J].Am J Respir Crit Care Med,2019,199:377-379.
[2]	WU Y,HUANG R,ZHONG X,et al.Cardiovascular Consequences of Repetitive Arousals over the Entire Sleep Duration[J].Biomed Res Int,2017,2017:4213861.
[3]	中国医师学会睡眠医学专业委员会.成人阻塞性睡眠呼吸暂停多学科诊疗指南[J].中华医学杂志,2018,98(24):1902-1914.
[4]	JAVAHERI S,BARBE F,CAMPOS-RODRIGUEZ F,et al.Sleep Apnea:Types,Mechanisms,and Clinical Cardiovascular Consequences[J].J Am Coll Cardiol,2017,69:841-858.
[5]	FIHN S D,BLANKENSHIP J C,ALEXANDER K P,et al.2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines,and the American Association for Thoracic Surgery,Preventive Cardiovascular Nurses Association,Society for Cardiovascular Angiography and Interventions,and Society of Thoracic Surgeons[J].J Thorac Cardiovasc Surg,2015,149:e5-e23.
[6]	WANG X,FAN J Y,ZHANG Y,et al.Association of obstructive sleep apnea with cardiovascular outcomes after percutaneous coronary intervention:A systematic review and meta-analysis[J].Medicine,2018,97:e0621.
[7]	中国心血管病报告编写组.中国心血管病报告2017概要[J].中国循环杂志,2018,33(1):1-8.
[8]	JAVAHERI S,BARBE F,CAMPOS-RODRIGUEZ F,et al.Sleep Apnea:Types,Mechanisms,and Clinical Cardiovascular Consequences[J].J Am Coll Cardiol,2017,69:841-858.
[9]	VIREND K,SOMERS M D,DPHIL,et al.Cardiology Foundation Scientific Statement From the American Heart Association Council for High Blood Pressure Research Professional Education Committee,Council on Clinical Cardiology,Stroke Council,and Council on Cardiovascular Nursing In Collaboration With the National Heart,Lung,and Blood Institute National Center on Sleep Disorders Research(National Institutes of Health)[J].J American College of Cardiology,2008,52:686-717.
[10]	LINZ D,BAUMERT M,CATCHESIDE P,et al.Assessment and interpretation of sleep disordered breathing severity in cardiology:Clinical implications and perspectives[J].Int J Cardiol,2018,271:281-288.
[11]	GESSNER V,BITTER T,HORSTKOTTE D,et al.Impact of sleep-disordered breathing in patients with acute myocardial infarction:a retrospective analysis[J].J Sleep Res,2017,26:657-664.
[12]	STROTMANN J,FOX H,BITTER T,et al.Characteristics of sleep-disordered breathing in patients with atrial fibrillation and preserved left ventricular ejection fraction[J].Clin Res Cardiol,2018,107:120-129.
[13]	CHOPRA S,RATHORE A,YOUNAS H,et al.Obstructive Sleep Apnea Dynamically Increases Nocturnal Plasma Free Fatty Acids,Glucose,and Cortisol During Sleep[J].J Clin Endocrinol Metab,2017,102:3172-3181.
[14]	KUNDEL V,TRIVIERI M G,KARAKATSANIS N A,et al.Assessment of atherosclerotic plaque activity in patients with sleep apnea using hybrid positron emission tomography/magnetic resonance imaging(PET/MRI):a feasibility study[J].Sleep Breath,2018,22:1125-1135.
[15]	LEE C H,SETHI R,LI R,et al.Obstructive Sleep Apnea and Cardiovascular Events After Percutaneous Coronary Intervention[J].Circulation,2016,133:2008-2017.
[16]	LEWIS E F,WANG R,PUNJABI N,et al.Impact of continuous positive airway pressure and oxygen on health status in patients with coronary heart disease,cardiovascular risk factors,and obstructive sleep apnea:A Heart Biomarker Evaluation in Apnea Treatment(HEARTBEAT)analysis[J].Am Heart J,2017,89:59-67.
[17]	YATSU S,NAITO R,KASAI T,et al.Influence of sleep-disordered breathing assessed by pulse oximetry on long-term clinical outcomes in patients who underwent percutaneous coronary intervention[J].Clin Res Cardiol,2018,107:711-718.
[18]	ZENG Y,YANG S,WANG X,et al.Prognostic impact of residual SYNTAX score in patients with obstructive sleep apnea and acute coronary syndrome:a prospective cohort study[J].Respir Res.2019,20(1):43.
[19]	CATALAN-SERRA P,CAMPOS-RODRIGUEZ F,REYES-NUÑEZ N,et al.Increased Incidence of Stroke,but Not Coronary Heart Disease,in Elderly Patients With Sleep Apnea[J].Stroke,2019,50:491-494.
[20]	CALCAIANU G,BRESSON D,CALCAIANU M,et al.The Importance of Apneic Events in Obstructive Sleep Apnea Associated with Acute Coronary Syndrome[J].Sleep Disord,2019,2019:6039147.