Kuniyoshi Fatima H Sert, Garcia-Touchard Arturo, Gami Apoor S, Romero-Corral Abel, van der Walt Christelle, Pusalavidyasagar Snigdha, Kara Tomas, Caples Sean M, Pressman Gregg S, Vasquez Elisardo C, Lopez-Jimenez Francisco, Somers Virend K
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
J Am Coll Cardiol. 2008 Jul 29;52(5):343-6. doi: 10.1016/j.jacc.2008.04.027.
This study sought to evaluate the day-night variation of acute myocardial infarction (MI) in patients with obstructive sleep apnea (OSA).
Obstructive sleep apnea has a high prevalence and is characterized by acute nocturnal hemodynamic and neurohormonal abnormalities that may increase the risk of MI during the night.
We prospectively studied 92 patients with MI for which the time of onset of chest pain was clearly identified. The presence of OSA was determined by overnight polysomnography.
For patients with and without OSA, we compared the frequency of MI during different intervals of the day based on the onset time of chest pain. The groups had similar prevalence of comorbidities. Myocardial infarction occurred between 12 am and 6 am in 32% of OSA patients and 7% of non-OSA patients (p = 0.01). The odds of having OSA in those patients whose MI occurred between 12 am and 6 am was 6-fold higher than in the remaining 18 h of the day (95% confidence interval: 1.3 to 27.3, p = 0.01). Of all patients having an MI between 12 am and 6 am, 91% had OSA.
The diurnal variation in the onset of MI in OSA patients is strikingly different from the diurnal variation in non-OSA patients. Patients with nocturnal onset of MI have a high likelihood of having OSA. These findings suggest that OSA may be a trigger for MI. Patients having nocturnal onset of MI should be evaluated for OSA, and future research should address the effects of OSA therapy for prevention of nocturnal cardiac events.
本研究旨在评估阻塞性睡眠呼吸暂停（OSA）患者急性心肌梗死（MI）的昼夜变化。
阻塞性睡眠呼吸暂停患病率高，其特征为急性夜间血流动力学和神经激素异常，这可能增加夜间发生心肌梗死的风险。
我们前瞻性研究了92例胸痛发作时间明确的心肌梗死患者。通过整夜多导睡眠图确定是否存在阻塞性睡眠呼吸暂停。
对于有和没有阻塞性睡眠呼吸暂停的患者，我们根据胸痛发作时间比较了一天中不同时间段内心肌梗死的发生频率。两组合并症的患病率相似。32%的阻塞性睡眠呼吸暂停患者和7%的非阻塞性睡眠呼吸暂停患者在凌晨12点至6点之间发生心肌梗死（p = 0.01）。心肌梗死发生在凌晨12点至6点之间的患者患阻塞性睡眠呼吸暂停的几率比一天中其余18小时高6倍（95%置信区间：1.3至27.3，p = 0.01）。在凌晨12点至6点之间发生心肌梗死的所有患者中，91%患有阻塞性睡眠呼吸暂停。
阻塞性睡眠呼吸暂停患者心肌梗死发作的昼夜变化与非阻塞性睡眠呼吸暂停患者的昼夜变化明显不同。夜间发生心肌梗死的患者患阻塞性睡眠呼吸暂停的可能性很高。这些发现表明阻塞性睡眠呼吸暂停可能是心肌梗死的一个触发因素。夜间发生心肌梗死的患者应评估是否患有阻塞性睡眠呼吸暂停，未来的研究应探讨阻塞性睡眠呼吸暂停治疗对预防夜间心脏事件的影响。
