Glantz Helena, Johansson Magnus C, Thunström Erik, Guron Cecilia Wallentin, Uzel Harun, Saygin Mustafa, Herlitz Johan, Peker Yüksel
Dept. of Internal Medicine, Skaraborg Hospital, Lidköping, Sweden.
Dept. of Molecular and Clinical Medicine/Clinical Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.
Int J Cardiol. 2017 Aug 15;241:12-18. doi: 10.1016/j.ijcard.2017.03.100. Epub 2017 Mar 25.
Obstructive sleep apnea (OSA) has been associated with worse diastolic function in patients with coronary artery disease (CAD). This analysis determined whether continuous positive airway pressure (CPAP) treatment would improve diastolic function in CAD patients with nonsleepy OSA.
Between December 2005 and November 2010, 244 revascularized CAD patients with nonsleepy OSA (apnea-hypopnea index (AHI) ≥15/h, Epworth Sleepiness Scale [ESS] score<10) were randomly assigned to CPAP or no-CPAP. Echocardiographic measurements were obtained at baseline, and after 3 and 12months.
A total of 171 patients with preserved left ventricular ejection fraction (≥50%), no atrial fibrillation or severe valve abnormalities, and technically adequate echocardiograms at baseline and follow-up visits were included (CPAP, n=87; no-CPAP, n=84). In the intention-to-treat analysis, CPAP had no significant effect on echocardiographic parameters of mild (enlarged left atrium or decreased diastolic relaxation velocity) or worse (increased E/é filling index [presumed elevated left ventricular filling pressure]) diastolic function. Post-hoc analysis revealed a significant association between CPAP usage for ≥4h/night and an increase in diastolic relaxation velocity at 12months' follow-up (odds ratio 2.3, 95% confidence interval 1.0-4.9; p=0.039) after adjustment for age, sex, body mass index, and left atrium diameter at baseline.
CPAP did not improve diastolic dysfunction in CAD patients with nonsleepy OSA. However, good CPAP adherence was significantly associated with an increase in diastolic relaxation velocity after one year.
阻塞性睡眠呼吸暂停（OSA）与冠状动脉疾病（CAD）患者较差的舒张功能相关。本分析旨在确定持续气道正压通气（CPAP）治疗是否能改善非嗜睡性OSA的CAD患者的舒张功能。
2005年12月至2010年11月期间，244例接受血运重建的非嗜睡性OSA的CAD患者（呼吸暂停低通气指数[AHI]≥15次/小时，爱泼沃斯嗜睡量表[ESS]评分<10）被随机分配至CPAP组或非CPAP组。在基线、3个月和12个月后进行超声心动图测量。
共有171例左心室射血分数保留（≥50%）、无房颤或严重瓣膜异常且在基线和随访时超声心动图技术上足够的患者纳入分析（CPAP组，n = 87；非CPAP组，n = 84）。在意向性分析中，CPAP对轻度（左心房增大或舒张期松弛速度降低）或更严重（E/é充盈指数增加[推测左心室充盈压升高]）舒张功能的超声心动图参数无显著影响。事后分析显示，在调整年龄、性别、体重指数和基线时的左心房直径后，每晚使用CPAP≥4小时与12个月随访时舒张期松弛速度增加显著相关（比值比2.3，95%置信区间1.0 - 4.9；p = 0.039）。
CPAP不能改善非嗜睡性OSA的CAD患者的舒张功能障碍。然而，良好的CPAP依从性与一年后舒张期松弛速度增加显著相关。
