阻塞性睡眠呼吸暂停会抑制急性心肌梗死患者左心室功能的恢复。

Obstructive sleep apnoea inhibits the recovery of left ventricular function in patients with acute myocardial infarction.

作者信息

Nakashima Hiroshi, Katayama Toshiro, Takagi Chisa, Amenomori Kentarou, Ishizaki Masahiko, Honda Yukiharu, Suzuki Shin

机构信息

Department of Cardiology, Nagasaki Citizens Hospital, Schinchi-machi 6-39, Nagasaki, Japan.

出版信息

Eur Heart J. 2006 Oct;27(19):2317-22. doi: 10.1093/eurheartj/ehl219. Epub 2006 Sep 6.

DOI:10.1093/eurheartj/ehl219

PMID:16956914

Abstract

AIMS

It has been suggested that obstructive sleep apnoea syndrome (OSA) may be a direct cause of left ventricular (LV) systolic dysfunction. This study was designed to examine our hypothesis that OSA inhibits the recovery of LV function in patients with acute myocardial infarction (AMI).

METHODS AND RESULTS

Our 86 consecutive first-AMI patients underwent primary percutaneous coronary intervention (PCI). All patients underwent polysomnography and OSA was defined as an apnoea-hypoapnoea index (AHI) > or =15 events/h, of which more than 50% were obstructive. Left ventriculograms immediately after PCI and at 21 days were used to evaluate LV ejection fraction (LVEF), LV end-diastolic volume index, and regional wall motion (RWM) within the infarct area. OSA was observed in 37 patients (43%). All three indices of LV function after primary PCI were comparable between the two groups. Increases in LVEF and RWM during admission were significantly lower in OSA patients than those without OSA (delta LVEF: -0.3+/-9.6 vs. 7.4+/-7.2%, P < 0.001; delta RWM: 0.26+/-1.04 SD/chord vs. 1.16+/-1.20 SD/chord, P = 0.002). Multiple regression analysis showed that AHI correlated negatively with delta LVEF and delta RWM.

CONCLUSION

The novel finding is that OSA may inhibit the recovery of LV function in patients with AMI.

摘要

目的

有人提出阻塞性睡眠呼吸暂停综合征（OSA）可能是左心室（LV）收缩功能障碍的直接原因。本研究旨在检验我们的假设，即OSA会抑制急性心肌梗死（AMI）患者左心室功能的恢复。

方法与结果

我们连续纳入了86例首次发生AMI的患者，均接受了直接经皮冠状动脉介入治疗（PCI）。所有患者均接受了多导睡眠监测，OSA定义为呼吸暂停低通气指数（AHI）≥15次/小时，其中超过50%为阻塞性。PCI术后即刻及术后21天的左心室造影用于评估左心室射血分数（LVEF）、左心室舒张末期容积指数以及梗死区域的节段性室壁运动（RWM）。37例患者（43%）存在OSA。两组患者PCI术后左心室功能的所有三项指标均具有可比性。OSA患者入院期间LVEF和RWM的增加显著低于无OSA的患者（LVEF变化值：-0.3±9.6%对7.4±7.2%，P<0.001；RWM变化值：0.26±1.04标准差/弦对1.16±1.20标准差/弦，P = 0.002）。多元回归分析显示AHI与LVEF变化值和RWM变化值呈负相关。