Van den Broecke Sandra, Jobard Olivier, Montalescot Gilles, Bruyneel Marie, Ninane Vincent, Arnulf Isabelle, Similowski Thomas, Attali Valérie
AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil, Paris, France; Service de Pneumologie, CHU St Pierre, Université Libre de Bruxelles, Brussels, Belgium.
AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Institut de Cardiologie, ACTION Group, Université Paris-6, Paris, France.
Sleep Med. 2014 Dec;15(12):1539-46. doi: 10.1016/j.sleep.2014.06.017. Epub 2014 Aug 26.
Obstructive sleep apnea (OSA) is frequently associated with acute coronary syndrome (ACS). Screening of sleep-disordered breathing (SDB) has not been previously evaluated in ACS within 72 h in intensive care settings and its management could potentially enhance patients' prognosis. This pilot study assessed the feasibility of SDB screening at the early phase of ACS.
All consecutive patients admitted to the coronary care unit (CCU) for ACS without acute heart failure underwent one overnight-attended polysomnography (PSG) within 72 h after admission. A telemonitoring (TM) system was set up to remotely monitor the signals and repair faulty sensors. The 27 recordings were analyzed as respiratory polygraphy (RP) and as PSG, and the results were compared.
The TM system allowed successful intervention in 48% of recordings, resulting in excellent quality PSG for 89% of cases. The prevalence of SDB [apnea-hypopnea index (AHI) ≥ 15/h] was 82% and mainly consisted of central SDB and periodic breathing, except three patients with OSA. Compared with PSG, RP underestimated AHI, probably due to the poor sleep efficiency, reduction of slow-wave sleep, and alteration of rapid eye movement sleep.
An early SDB screening by remote-attended PSG is feasible in ACS patients shortly after admission to CCU. The TM enhanced the quality of PSG. A high prevalence of central SDB was noticed, for which the etiology remains unknown. Further large-scale studies are needed to determine whether central SDB is an incidental finding in early ACS and whether the presence and severity of SDB have a prognostic impact.
阻塞性睡眠呼吸暂停（OSA）常与急性冠状动脉综合征（ACS）相关。此前尚未在重症监护环境中对72小时内的ACS患者进行睡眠呼吸障碍（SDB）筛查评估，而对其进行管理可能会改善患者的预后。这项前瞻性研究评估了在ACS早期进行SDB筛查的可行性。
所有因ACS入住冠心病监护病房（CCU）且无急性心力衰竭的连续患者在入院后72小时内接受一次有专人值守的整夜多导睡眠图（PSG）检查。设置了一个远程监测（TM）系统以远程监测信号并修复故障传感器。将27份记录作为呼吸多导记录（RP）和PSG进行分析，并比较结果。
TM系统成功干预了48%的记录，使89%的病例获得了高质量的PSG。SDB[呼吸暂停低通气指数（AHI）≥15次/小时]的患病率为82%，主要包括中枢性SDB和周期性呼吸，另有3例OSA患者。与PSG相比，RP低估了AHI，这可能是由于睡眠效率低下、慢波睡眠减少和快速眼动睡眠改变所致。
在CCU入院后不久，通过远程值守的PSG对ACS患者进行早期SDB筛查是可行的。TM提高了PSG的质量。注意到中枢性SDB的患病率很高，其病因尚不清楚。需要进一步开展大规模研究以确定中枢性SDB是否是早期ACS中的偶然发现，以及SDB的存在和严重程度是否具有预后影响。
