Division of Cardiology, Hospital de Clínicas de Porto Alegre, Graduate Programs in Medical Sciences and in Cardiological Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Sleep Breath. 2012 Sep;16(3):695-701. doi: 10.1007/s11325-011-0559-0. Epub 2011 Jul 28.
Sleep apnea (SA) may be linked to coronary artery disease (CAD). Both conditions have similar risk factors, confounding the analyses. Investigation of the lipid profile is routine in the adult population, even without symptoms or suspected cardiac ailment. SA, however, remains underdiagnosed even in the presence of unambiguous clinical manifestations.
The aim of this study was to verify the association between SA and CAD, adjusting for usual CAD risk factors.
Patients who underwent diagnostic or therapeutic coronariography and portable type III polysomnography were studied. The severity of SA was determined by the apnea-hypopnea index (AHI). We measured classic CAD risk factors: fasting glucose; total, HDL, and LDL cholesterols; triglycerides; uric acid, and high-sensitivity C-reactive protein. We excluded patients older than 65 years, with body mass index higher than 40 kg/m(2), with diabetes, and with history of smoking in the last year.
Of 55 included patients, 28 had AHI > 14, showing an odds ratio of 8.7 for CAD. Patients without (n = 29) and with CAD (n = 26), showed AHI of, respectively, 11 ± 11 and 23 ± 14 per hour (P = 0.001). In a binary logistic regression to predict CAD, controlling for all the above risk factors, the only variables entered in the stepwise model were AHI (either as continuous or categorical variable) and uric acid.
In a sample without smokers, morbidly obese, or diabetic patients, AHI is the main predictor of CAD. SA should integrate the set of risk factors routinely assessed in clinical investigation for coronary disease risk stratification.
睡眠呼吸暂停（SA）可能与冠状动脉疾病（CAD）有关。这两种疾病都有相似的危险因素，这使得分析变得复杂。即使没有症状或疑似心脏疾病，对成年人进行血脂谱检查也是常规的。然而，即使有明确的临床表现，SA 仍然被漏诊。
本研究旨在验证 SA 与 CAD 之间的关联，并调整常见的 CAD 危险因素。
研究对象为接受诊断或治疗性冠状动脉造影和便携式 III 型多导睡眠图检查的患者。SA 的严重程度通过呼吸暂停低通气指数（AHI）来确定。我们测量了经典的 CAD 危险因素：空腹血糖；总胆固醇、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇；甘油三酯；尿酸和高敏 C 反应蛋白。我们排除了年龄大于 65 岁、体重指数大于 40kg/m²、患有糖尿病和在过去一年中有吸烟史的患者。
在 55 名纳入的患者中，28 名患者的 AHI 大于 14，CAD 的比值比为 8.7。无 CAD（n=29）和有 CAD（n=26）的患者的 AHI 分别为每小时 11±11 和 23±14（P=0.001）。在一个二元逻辑回归分析中，以预测 CAD 为因变量，控制所有上述危险因素，只有 AHI（无论是连续变量还是分类变量）和尿酸被逐步模型纳入。
在一个没有吸烟者、病态肥胖或糖尿病患者的样本中，AHI 是 CAD 的主要预测因素。SA 应纳入常规评估的一组危险因素，用于冠心病风险分层。
