Loo Germaine, Tan Adeline Y, Koo Chieh-Yang, Tai Bee-Choo, Richards Mark, Lee Chi-Hang
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Division of Respiratory and Critical Care Medicine, National University Health System, Singapore.
Sleep Med. 2014 Jun;15(6):631-6. doi: 10.1016/j.sleep.2014.02.009. Epub 2014 Apr 13.
We aimed to determine the prognostic implications of obstructive sleep apnea (OSA) diagnosed during the recovery phase of acute coronary syndrome (ACS).
Patients presenting with ACS and treated with percutaneous coronary intervention were recruited prospectively for a home-based sleep study within 30 days of hospital discharge. Major adverse cardiac and cerebrovascular events (MACCEs) assessed included cardiac death, myocardial infarction, stroke, unplanned revascularization, and hospitalization for heart failure.
Of the 85 patients recruited, 68 successfully completed the study. The median time from percutaneous coronary intervention to sleep study was 14 days (interquartile range: 7.5-27 days). OSA was diagnosed in 24 patients (35.3%) (apnea-hypopnea index > or =15). A drug-eluting stent was implanted into the target lesion in 45 patients (66.2%). None of the study patients had received treatment for OSA. At 24-month follow-up, the MACCE incidence was 34.9% in the OSA group and 5.1% in the non-OSA group (P=0.008, log-rank test). After adjusting for the possible confounding effect of age, gender, coronary intervention indications, hypertension, smoking, and body mass index, OSA remained an independent predictor of MACCEs (adjusted hazard ratio, 6.95; 95% confidence interval, 1.17-41.4; P=0.033).
OSA diagnosed in patients treated with percutaneous coronary intervention for ACS by post-discharge sleep studies conducted 2 weeks after percutaneous coronary intervention was independently associated with MACCEs at 24-month follow-up.
我们旨在确定在急性冠状动脉综合征（ACS）恢复阶段诊断出的阻塞性睡眠呼吸暂停（OSA）的预后意义。
前瞻性招募接受经皮冠状动脉介入治疗的ACS患者，在出院后30天内进行家庭睡眠研究。评估的主要不良心脑血管事件（MACCE）包括心源性死亡、心肌梗死、中风、非计划血管重建和因心力衰竭住院。
在招募的85例患者中，68例成功完成研究。从经皮冠状动脉介入治疗到睡眠研究的中位时间为14天（四分位间距：7.5 - 27天）。24例患者（35.3%）诊断为OSA（呼吸暂停低通气指数≥15）。45例患者（66.2%）在靶病变处植入了药物洗脱支架。所有研究患者均未接受过OSA治疗。在24个月的随访中，OSA组的MACCE发生率为34.9%，非OSA组为5.1%（P = 0.008，对数秩检验）。在调整年龄、性别、冠状动脉介入指征、高血压、吸烟和体重指数的可能混杂效应后，OSA仍然是MACCE的独立预测因素（调整后的危险比为6.95；95%置信区间为1.17 - 41.4；P = 0.033）。
经皮冠状动脉介入治疗ACS的患者在术后2周进行出院后睡眠研究诊断出的OSA与24个月随访时的MACCE独立相关。
