Koehler U, Dübler H, Glaremin T, Junkermann H, Lübbers C, Ploch T, Peter J H, Pomykaj T, von Wichert P
Zentrum Innere Medizin, Medizinische Poliklinik, Philipps-Universität Marburg.
Klin Wochenschr. 1991 Aug 1;69(11):474-82. doi: 10.1007/BF01649418.
To study the effect of apnea and hypoventilation-induced hypoxemia on the heart, we carried out polysomnographic recordings over 4 nights with electrocardiographic tracings in 30 patients with and without coronary heart disease. Evaluations of the data were based on the 2nd and 4th nights. In six subjects, five with coronary heart disease, we found 85 episodes of nocturnal ischemia, mainly during REM sleep (83.5%), high apnea activity, and sustained and progressive hypoxemia. Complex ventricular ectopy was observed in 14/13 patients (nights 2/4) and repetitive ventricular ectopy in 5/3. There was no significant difference in the quality and quantity of ventricular ectopy during wake and sleep states between the CHD group and the control group. In one patient ventricular bigeminy was observed only at a threshold of SaO2 below 60%. Bradyarrhythmia was made evident in four subjects from the CHD group and correlated mainly with apnea activity. We suppose that patients with sleep apnea and CHD are at cardiac risk because coronary heart disease can be aggravated by insufficient arterial oxygen supply due to cumulative phase of apnea and hypoventilation. The reduced hypoxic tolerance of the heart may lead to myocardial ischemia and increased electrical instability.
为研究呼吸暂停和通气不足所致低氧血症对心脏的影响，我们对30例有或无冠心病的患者进行了4个晚上的多导睡眠图记录，并同步记录心电图。数据评估基于第2晚和第4晚。在6例受试者中，5例患有冠心病，我们发现85次夜间缺血发作，主要发生在快速眼动睡眠期（占83.5%），呼吸暂停活动频繁，且存在持续性和进行性低氧血症。14/13例患者（第2/4晚）观察到复杂性室性早搏，5/3例患者观察到重复性室性早搏。冠心病组和对照组在清醒和睡眠状态下室性早搏的性质和数量无显著差异。仅在1例患者中，当血氧饱和度低于60%时观察到室性二联律。冠心病组4例患者出现缓慢性心律失常，主要与呼吸暂停活动相关。我们推测，睡眠呼吸暂停合并冠心病的患者存在心脏风险，因为呼吸暂停和通气不足的累积阶段导致的动脉氧供应不足会加重冠心病。心脏对缺氧耐受性降低可能导致心肌缺血和电不稳定性增加。
