Department of Pneumology, Donaustauf Hospital, Donaustauf, Germany.
Department of Internal Medicine II, Cardiology and Pneumology, University Hospital Regensburg, Regensburg, Germany.
Chest. 2013 May;143(5):1294-1301. doi: 10.1378/chest.12-1930.
Sleep-disordered breathing (SDB) may promote an increase in cardiac workload early after acute myocardial infarction (AMI). We tested the hypothesis that in the early phase after AMI, SDB is associated with increased 24-h arterial BP, heart rate (HR), and, thus, cardiac workload.
In this prospective study, 55 consecutive patients with AMI and subsequent percutaneous coronary intervention (78% men; mean age, 54 ± 10 y; mean BMI, 28.3 ± 3.6 kg/m²; mean left ventricular ejection fraction [LVEF], 47% ± 8%) underwent polysomnography and 24-h ambulatory BP and heart rate monitoring within 5 days after MI. Cardiac workload was calculated as systolic BP multiplied by HR. The presence of SDB was defined as ≥ 10 apneas and hypopneas per hour of sleep.
Fifty-five percent of the patients had SDB, of which 40% was predominantly central in nature. Patients with SDB had higher 24-h HR and systolic and diastolic BP compared with those without SDB (115 vs 108 mm Hg, P = .029; 71 vs 67 mm Hg, P = .034; 69 vs 64 beats/min, P = .050, respectively). Use of antihypertensive medication and β-receptor blockers was similar in both groups. In a multivariate linear regression analysis, SDB was significantly associated with an increased 24-h cardiac workload (β-coefficient, 0.364; 95% CI, 0.071-0.657; P = .016), independently of age, sex, BMI, LVEF, and antihypertensive medication.
Patients with AMI and SDB have significantly increased 24-h BP, HR, and cardiac workload. Treatment of SDB may be a valuable nonpharmacologic approach to lower cardiac workload in these patients.
睡眠呼吸障碍（SDB）可能会增加急性心肌梗死（AMI）后早期的心脏工作量。我们检验了这样一个假设，即在 AMI 后的早期阶段，SDB 与 24 小时动脉血压、心率（HR）的增加有关，从而与心脏工作量的增加有关。
在这项前瞻性研究中，55 例连续的 AMI 患者在随后进行经皮冠状动脉介入治疗（78%为男性；平均年龄 54±10 岁；平均 BMI 为 28.3±3.6kg/m²；平均左心室射血分数[LVEF]为 47%±8%），在 MI 后 5 天内行多导睡眠图和 24 小时动态血压和心率监测。心脏工作量定义为收缩压乘以心率。SDB 的存在定义为每小时睡眠时≥10 次的呼吸暂停和低通气。
55%的患者存在 SDB，其中 40%主要为中枢性。与无 SDB 的患者相比，SDB 患者的 24 小时 HR、收缩压和舒张压均较高（115 对 108mmHg，P=0.029；71 对 67mmHg，P=0.034；69 对 64 次/分，P=0.050）。两组患者使用抗高血压药物和β受体阻滞剂的情况相似。在多元线性回归分析中，SDB 与 24 小时心脏工作量的增加显著相关（β系数为 0.364；95%CI 为 0.071-0.657；P=0.016），独立于年龄、性别、BMI、LVEF 和抗高血压药物。
AMI 合并 SDB 的患者 24 小时血压、HR 和心脏工作量显著增加。治疗 SDB 可能是降低这些患者心脏工作量的一种有价值的非药物方法。
