Kaitani Kazuaki, Kondo Hirokazu, Hanazawa Koji, Onishi Naoaki, Hayama Yukiko, Tsujimura Akira, Kuroda Maiko, Nishimura Shunsuke, Yoshikawa Yusuke, Takahashi Yusuke, Amano Masashi, Imamura Sari, Tamaki Yodo, Enomoto Soichiro, Miyake Makoto, Tamura Toshihiro, Motooka Makoto, Izumi Chisato, Nakagawa Yoshihisa
Department Cardiology, Tenri Hospital, Tenri, Nara, Japan.
Division of Cardiology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan.
Heart Vessels. 2016 Jul;31(7):1140-7. doi: 10.1007/s00380-015-0705-x. Epub 2015 Jul 1.
Sleep-disordered breathing (SDB) is recognized as a primary factor or mediator of atrial fibrillation (AF). We hypothesized that the severity of SDB among AF ablation candidates would be associated with left ventricular diastolic dysfunction (LVDD) even for subclinical SDB. A total of 246 patients hospitalized for initial pulmonary vein isolation (PVI) were analyzed. Known SDB cases were excluded. We measured the oxygen desaturation index (ODI) by pulse oximetry overnight as an indicator of SDB, and classified SDB severity by 3 % ODI as normal (ODI < 5 events/h), mild (ODI ≤ 5 to <15 events/h), or moderate-to-severe (ODI ≥15 events/h). The LVDD was assessed by echocardiography using combined categories with tissue Doppler imaging and left atrial (LA) volume measurement. Among the participants, 42 patients (17.1 %) had LVDD. The prevalence of LVDD increased with the SDB severity from 8.6 % (normal) to 12.7 % (mild) to 40.0 % (moderate-to-severe SDB) (p < 0.0001). In the multivariate logistic regression analysis, the odds ratio of having LVDD in the moderate-to-severe SDB group (ODI ≥ 15) vs. normal group (ODI < 5) was 5.96 (95 % CI, 2.10-19.00, P = 0.006). The presence of moderate-to-severe SDB in AF ablation candidates adversely affected LV diastolic function even during a subclinical state of SDB.
睡眠呼吸紊乱（SDB）被认为是心房颤动（AF）的主要因素或介导因素。我们假设，即使是亚临床SDB，房颤消融候选者中SDB的严重程度也与左心室舒张功能障碍（LVDD）相关。对总共246例因初次肺静脉隔离（PVI）住院的患者进行了分析。已知的SDB病例被排除。我们通过夜间脉搏血氧饱和度测定来测量氧饱和度下降指数（ODI）作为SDB的指标，并将SDB严重程度按3% ODI分类为正常（ODI < 5次/小时）、轻度（ODI ≤ 5至< 15次/小时）或中度至重度（ODI ≥ 15次/小时）。使用组织多普勒成像和左心房（LA）容积测量的联合类别通过超声心动图评估LVDD。在参与者中，42例患者（17.1%）有LVDD。LVDD的患病率随着SDB严重程度的增加而从8.6%（正常）增加到12.7%（轻度）再到40.0%（中度至重度SDB）（p < 0.0001）。在多变量逻辑回归分析中，中度至重度SDB组（ODI ≥ 15）与正常组（ODI < 5）相比发生LVDD的优势比为5.96（95% CI，2.10 - 19.00，P = 0.006）。房颤消融候选者中存在中度至重度SDB即使在SDB的亚临床状态下也会对左心室舒张功能产生不利影响。
