The Relationship Between Obstructive Sleep Apnea Hypopnea Syndrome and Inflammatory Markers and Quality of Life in Subjects With Acute Coronary Syndrome
The Relationship Between Obstructive Sleep Apnea Hypopnea Syndrome and Inflammatory Markers and Quality of Life in Subjects With Acute Coronary Syndrome
复制标题
阻塞性睡眠呼吸暂停低通气综合征与急性冠脉综合征患者炎症标志物和生活质量的关系
DOI：
10.4187/respcare.04571
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发表时间：
2016-09-01
期刊：
影响因子：
2.5
通讯作者：
Wei, Yongxiang
中科院分区：
文献类型：
--
作者：
Wu, Hao;Yuan, Xiandao;Wei, Yongxiang
背景技术背景：本研究的目的是探讨急性冠脉综合征患者，尤其是接受经皮冠状动脉介入治疗的患者，阻塞性睡眠呼吸暂停（OSA）与炎症标志物和生活质量之间的关系。方法：118例急性冠状动脉综合征患者入院时有阻塞性睡眠呼吸暂停症状，多导睡眠图阳性。在这些受试者中，53人在入院期间接受了直接经皮冠状动脉介入治疗，65人接受了药物治疗。然后我们比较了OSA状态的炎症标志物。我们还使用西雅图心绞痛问卷评估心脏症状，使用埃普沃思嗜睡量表评估睡眠症状。研究结果：与药物治疗组相比，经皮冠状动脉介入治疗组受试者的氧饱和度下降指数（ODI）（P = 0.02）和呼吸暂停低通气指数（AHI）（P = 0.048）更高。在经皮冠状动脉介入治疗受试者中，中重度OSA组（AHI ≥ 15/h）的红细胞压积（P = 0.047）、同型半胱氨酸（P = 0.01）和高敏C反应蛋白（P = 0.045）高于无OSA或轻度OSA组（AHI < 15/h）。超敏C反应蛋白与AHI（r = 0.46，P = 0.001）和ODI（r = 0.47，P <0.001）均显著相关。根据西雅图心绞痛问卷的分量表判断，与无或轻度OSA的患者相比，中重度OSA患者的埃普沃思嗜睡量表评分较高（P = .002），身体受限程度较高（P = .01），治疗满意度和疾病感知较低（P = .007）。最后，接受经皮冠状动脉介入治疗的受试者中，AHI（r = 0.48，P <0.001）和ODI（r = 0.49，P <0.001）较低的受试者报告了较高的治疗满意度。结论：接受经皮冠状动脉介入治疗的急性冠状动脉综合征患者中，中重度OSA患者的炎症介质水平较高，治疗满意度和疾病感知较低。这些因素可能通过增加全身炎症反应而增加不良后遗症的风险。
BACKGROUND: The objective of this work was to examine the relationship between obstructive sleep apnea (OSA) and inflammatory markers and quality of life in patients with acute coronary syndrome, especially undergoing percutaneous coronary intervention. METHODS: One hundred eighteen subjects were admitted with acute coronary syndrome over 1 y who had symptoms of OSA and positive polysomnography on admission. Of these subjects, 53 underwent primary percutaneous coronary intervention during their admission, and 65 had medical management. We then compared inflammatory markers by OSA status. We also assessed cardiac symptoms using the Seattle Angina Questionnaire and sleep symptoms using the Epworth Sleepiness Scale. RESULTS: Subjects in the percutaneous coronary intervention group had a higher oxygen desaturation index (ODI) (P = .02) and apnea-hypopnea index (AHI) (P = .048) compared with those in the medical management group. In percutaneous coronary intervention subjects, the moderate-severe OSA group (AHI ≥ 15/h) had a higher hematocrit (P = .047), homocysteine (P = .01), and high-sensitivity C-reactive protein (P = .045) compared with those with no or mild OSA (AHI < 15/h). There was a significant correlation between high-sensitivity C-reactive protein and both AHI (r = 0.46, P = .001) and ODI (r = 0.47, P < .001). Those with moderate-severe OSA had higher Epworth Sleepiness Scale (P = .002), greater physical limitation (P = .01), and lower treatment satisfaction and disease perception (P = .007), as judged by subscales of the Seattle Angina Questionnaire, compared with those with no or mild OSA. Finally, subjects undergoing percutaneous coronary intervention with lower AHI (r = 0.48, P < .001) and ODI (r = 0.49, P < .001) reported higher treatment satisfaction. CONCLUSIONS: Subjects with acute coronary syndrome undergoing percutaneous coronary intervention who had moderate-severe OSA showed higher levels of inflammatory mediators and lower treatment satisfaction and disease perception. These factors may increase the risk of adverse sequelae by increasing the systemic inflammatory response.