Zhang Jin, Tan Hai, Shi Xue-ning, Zheng Xi-wei, Li Yu-mei, Li Shou-fen, Ma Zi-yun
Department of Respiratory Medicine, Affiliated Hospital of NingXia Medical College, Yinchuan 750004, China.
Zhonghua Nei Ke Za Zhi. 2006 Mar;45(3):188-91.
To 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.
A 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 MSpO2, CT90 were analyzed.
(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 MSpO2, 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 MSpO2 (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 MSpO2 (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, MSpO2, 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).
OSAHS 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.
研究阻塞性睡眠呼吸暂停低通气综合征（OSAHS）与冠心病（CHD）患者血管内皮功能指标的相关性以及经鼻持续气道正压通气（nCPAP）对OSAHS合并CHD患者的影响。
前瞻性纳入80例受试者，分为对照组、OSAHS组、CHD组、OSAHS合并CHD组，每组20例。测定睡眠呼吸暂停指标、血清一氧化氮（NO）及血浆内皮素-1（ET-1）水平。比较nCPAP治疗前后ET-1和NO浓度变化。分析ET-1、NO与最低血氧饱和度（MSpO2）、血氧饱和度低于90%的时间占总睡眠时间的百分比（CT90）的相关性。
（1）多因素logistic分析显示，OSAHS是CHD的危险因素之一（OR = 0.511）。（2）与对照组和CHD组相比，OSAHS组及OSAHS合并CHD组的CT90、ET-1浓度显著升高，MSpO2、NO浓度显著降低（P < 0.01）。OSAHS组与OSAHS合并CHD组的睡眠呼吸暂停指标差异无统计学意义（P > 0.05）。然而，OSAHS合并CHD组的血浆ET-1显著高于单纯OSAHS组，血清NO显著低于单纯OSAHS组（P < 0.01）。（3）OSAHS组血清NO浓度与MSpO2呈正相关（r = 0.519，P < 0.05），与CT90呈负相关（r = -0.529，P < 0.05）。此外，血浆ET-1浓度与MSpO2呈负相关（r = -0.457，P < 0.05），与CT90呈正相关（r = 0.476，P < 0.05）。（4）OSAHS组和OSAHS合并CHD组经nCPAP治疗后，MSpO2、NO及NO/ET-1高于治疗前，CT90和ET-1低于治疗前（P < 0.01）。
OSAHS是CHD的危险因素之一。OSAHS患者血管内皮功能明显受损，OSAHS合并CHD患者受损更严重。血管内皮功能损害可能是OSAHS患者CHD发生或病情恶化的主要机制之一。nCPAP治疗可改善血管内皮功能障碍，这与夜间低氧血症的改善相关。
