Barceló Antonia, Esquinas Cristina, Bauçà Josep Miquel, Piérola Javier, de la Peña Mónica, Arqué Meritxell, Sánchez-de-la-Torre Manuel, Alonso-Fernández Alberto, Barbé Ferran
Servei d'Anàlisis Cliniques Hospital Universitari Son Espases, Palma de Mallorca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.
Servei de Pneumologia, Hospital Arnau de Vilanova, IRB Lleida, Spain.
Respir Med. 2014 Jul;108(7):1060-3. doi: 10.1016/j.rmed.2014.04.005. Epub 2014 Apr 23.
Obstructive sleep apnea (OSA) is associated with an increased prevalence of cardiovascular diseases. New generations of highly sensitive assays for cardiac troponin (hs-cTnT) have been introduced recently, and a number of clinical observations have challenged the notion that troponins are only increased in blood following irreversible necrosis.
The aims of this study were to compare the levels of hs-cTnT between a group of healthy controls and a group of patients with OSA without co-existent coronary artery disease, and to assess the possible influence of the treatment with Continuous positive airway pressure (CPAP) on these levels.
The study population included 200 male participants. The case (n = 133) or control (n = 67) status was defined by an apnea-hypopnea index of 10 or greater. The hs-cTnT assay was validated as reported previously, with a limit of detection of 3 ng/L and an upper reference limit (99th percentile) of 14 ng/L.
The proportion of subjects with detectable plasma hs-cTnT was higher in patients with OSA than in controls (61 vs 75%, p = 0.04). In patients, a significant increase in hs-cTnT levels was observed after an effective treatment with CPAP (7.3 ± 3.4 vs 10.1 ± 4.9 ng/L; p < 0.01).
This study shows that the percentage of subjects with detectable hs-cTnT is associated with the presence of OSA. It also evidences that treatment with CPAP is followed by a rise in hs-cTnT concentrations. It is reasonable to suggest that CPAP therapy might induce a potential degree of cardiac stress, resulting in deleterious consequences for the heart.
阻塞性睡眠呼吸暂停（OSA）与心血管疾病患病率增加有关。新一代高敏心肌肌钙蛋白检测方法（hs-cTnT）最近已被引入，并且一些临床观察结果对肌钙蛋白仅在不可逆坏死之后血液中才升高这一观念提出了挑战。
本研究的目的是比较一组健康对照者与一组无并存冠状动脉疾病的OSA患者之间hs-cTnT水平，并评估持续气道正压通气（CPAP）治疗对这些水平的可能影响。
研究人群包括200名男性参与者。根据呼吸暂停低通气指数为10或更高来定义病例组（n = 133）或对照组（n = 67）。hs-cTnT检测方法如先前报道那样经过验证，检测限为3 ng/L，参考上限（第99百分位数）为14 ng/L。
OSA患者中可检测到血浆hs-cTnT的受试者比例高于对照组（61%对75%，p = 0.04）。在患者中，CPAP有效治疗后观察到hs-cTnT水平显著升高（7.3±3.4对10.1±4.9 ng/L；p < 0.01）。
本研究表明，可检测到hs-cTnT的受试者百分比与OSA的存在有关。它还证明CPAP治疗后hs-cTnT浓度会升高。有理由认为CPAP治疗可能会诱发一定程度的心脏应激，对心脏产生有害后果。
