Alonderis Audrius, Varoneckas Giedrius, Raskauskiene Nijole, Brozaitiene Julija
Laboratory of Clinical Physiology and Rehabilitation, Behavioral Medicine Institute, Lithuanian University of Health Sciences, Palanga, Lithuania.
Laboratory of Psychosomatic Research, Behavioral Medicine Institute, Lithuanian University of Health Sciences, Palanga, Lithuania.
Ther Clin Risk Manag. 2017 Aug 18;13:1031-1042. doi: 10.2147/TCRM.S136651. eCollection 2017.
Sleep apnea (SA) is increasingly recognized as being important in the prognosis of patients with coronary artery disease (CAD); however, symptoms of SA are not easily identified, and as many as 80% of sufferers remain undiagnosed.
This cross-sectional study investigated the prevalence and predictors of SA that may help to increase the awareness and diagnosis of SA in stable CAD patients.
Polysomnography was performed in 772 medically stable CAD patients with untreated SA recruited from the Clinic of Cardiovascular Rehabilitation. Patients were predominantly male (76%), median age was 58 years (32-81). All subjects completed the Epworth sleepiness scale (ESS). The frequency of all apneas and hypopneas associated with 3% oxygen desaturation is referred to as the apnea-hypopnea index (AHI). Mild-to-severe SA was defined as AHI ≥5/h, moderate-to-severe SA as AHI ≥15/h.
AHI was within a range of values that was considered normal or only mildly elevated. The median AHI was 3.4 (interquartile range [IQR 1-9]), and 39% of patients had unrecognized mild-to-severe SA (moderate-to-severe in 14%), which was not higher than other known risk indicators for CAD such as hypertension and obesity (83% and 47%, respectively). These patients did not show sleepiness and the risk-related cut-off score for excessive daily sleepiness was lower than the official for ESS.
Hypertension, age, male gender, obesity, ESS ≥6, and left ventricular ejection fraction ≤45% were the best predictors of mild-to-severe SA. While, male gender, age 50-70 years and, mainly, the presence of obesity but not hypertension were clinical predictors for moderate-to-severe SA. In addition, association between mild-to-severe SA and obesity was not evident in women. SA is prevalent comorbidity in the stable CAD patients, especially in its asymptomatic mild form. We suggest that SA should be considered in the secondary prevention protocols for CAD.
睡眠呼吸暂停（SA）在冠状动脉疾病（CAD）患者的预后中日益被认为具有重要意义；然而，SA的症状不易识别，多达80%的患者仍未被诊断出来。
这项横断面研究调查了SA的患病率和预测因素，这可能有助于提高对稳定型CAD患者中SA的认识和诊断。
对从心血管康复诊所招募的772例患有未经治疗的SA的医学稳定的CAD患者进行了多导睡眠图检查。患者以男性为主（76%），中位年龄为58岁（32 - 81岁）。所有受试者均完成了爱泼华嗜睡量表（ESS）。与3%氧饱和度下降相关的所有呼吸暂停和低通气的频率称为呼吸暂停低通气指数（AHI）。轻度至重度SA定义为AHI≥5次/小时，中度至重度SA定义为AHI≥15次/小时。
AHI处于被认为正常或仅轻度升高的值范围内。中位AHI为3.4（四分位间距[IQR 1 - 9]），39%的患者存在未被识别的轻度至重度SA（14%为中度至重度），这并不高于CAD的其他已知风险指标，如高血压和肥胖（分别为83%和47%）。这些患者没有表现出嗜睡，并且每日过度嗜睡的风险相关临界值低于ESS的官方临界值。
高血压、年龄、男性、肥胖症、ESS≥6以及左心室射血分数≤45%是轻度至重度SA的最佳预测因素。而男性、50 - 70岁年龄以及主要是肥胖症的存在而非高血压是中度至重度SA的临床预测因素。此外，轻度至重度SA与肥胖症之间的关联在女性中不明显。SA在稳定型CAD患者中是常见的合并症，尤其是无症状的轻度形式。我们建议在CAD的二级预防方案中应考虑SA。
