Zhu Cai-Ping, Li Tao-Ping, Wang Xiao, Zhao Yu-Hua, Zhou Shi-Xi, Fu Yan, Jiang Yi-Wei, Xiao Xue-Ping
Department of Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
J Thorac Dis. 2017 Aug;9(8):2476-2483. doi: 10.21037/jtd.2017.07.50.
Sleep apnoea hypopnoea syndrome (SAHS) is characterised by repetitive nocturnal hypoxemia and has a high prevalence among patients with acute myocardial infarction (AMI). But there are few studies on patients with AMI undergoing emergency primary percutaneous coronary intervention (pPCI). In this study, we want to find the prevalence of SAHS among patients with AMI undergoing emergency pPCI and determine whether SAHS would worsen the condition among these people, and especially affect the damage degree of the coronary artery.
Over four months, 95 patients admitted for the first time for AMI were observed. All of them had emergency primary PCIs. A total of 86 patients accepted the sleep study and were divided into four groups according to the apnoea hypopnoea index (AHI): SAHS was diagnosed when AHI ≥5/h and was defined as mild for AHI ≥5/h and <15/h, moderate for AHI ≥15/h and <30/h, and severe for AHI ≥30/h. On the contrary, the patients whose AHI <5/h were Non-SAHS. And the characteristics of the patients among these four groups were compared. According to the time of chest pain onset, the number of the patients between SAHS and non-SAHS, and patients' AHI during three intervals of one day were measured and compared; Makers including the sensitivity of serum troponin T (hs-TnT), creatine kinase isoenzyme MB (CK-MB), left ventricular ejection fraction (LVEF), pro-brain-type natriuretic peptide (pro-BNP), Gensini score and collateral vessels between the SAHS and non-SAHS were compared. And the relationships between the AHI of these patients and the markers were analysed.
Of the 86 patients studied, 65 had SAHS, representing a SAHS prevalence of 75.58% among patients with AMI undergoing emergency pPCI. There were significant differences in average ages, smoking and arrhythmia (P<0.05) between these four groups. There was no significant difference between AMI patients with or without SAHS regarding the day-night pattern. But there showed significant differences between SAHS and non-SAHS in Gensini score (P<0.05) and pro-BNP (P<0.05). Also, there were positive correlations between AHI and Gensini score (r=0.490, P<0.05) and pro-BNP (r=0.338, P<0.05).
Among patients with AMI undergoing emergency pPCI, there is a high prevalence of SAHS. There are also positive correlations between AHI and Gensini score, and pro-BNP. Therefore, guided by the results, should we conduct a routine screening to those patients normally and could we relieve the damage to the coronary artery by curing the SAHS?
睡眠呼吸暂停低通气综合征（SAHS）的特征是夜间反复低氧血症，在急性心肌梗死（AMI）患者中患病率很高。但针对接受急诊直接经皮冠状动脉介入治疗（pPCI）的AMI患者的研究较少。在本研究中，我们想了解接受急诊pPCI的AMI患者中SAHS的患病率，并确定SAHS是否会使这些患者的病情恶化，特别是影响冠状动脉的损伤程度。
在四个月的时间里，观察了95例首次因AMI入院的患者。他们均接受了急诊直接经皮冠状动脉介入治疗。共有86例患者接受了睡眠研究，并根据呼吸暂停低通气指数（AHI）分为四组：AHI≥5/h时诊断为SAHS，AHI≥5/h且<15/h定义为轻度，AHI≥15/h且<30/h定义为中度，AHI≥30/h定义为重度。相反，AHI<5/h的患者为非SAHS。比较这四组患者的特征。根据胸痛发作时间，测量并比较SAHS组和非SAHS组患者在一天三个时间段内的AHI；比较SAHS组和非SAHS组之间包括血清肌钙蛋白T（hs-TnT）、肌酸激酶同工酶MB（CK-MB）、左心室射血分数（LVEF）、脑钠肽前体（pro-BNP）、Gensini评分和侧支血管等指标。并分析这些患者的AHI与指标之间的关系。
在研究的86例患者中，65例患有SAHS，在接受急诊pPCI的AMI患者中SAHS患病率为75.58%。这四组患者在平均年龄、吸烟和心律失常方面存在显著差异（P<0.05）。有或没有SAHS的AMI患者在昼夜模式方面没有显著差异。但SAHS组和非SAHS组在Gensini评分（P<0.05）和pro-BNP（P<0.05）方面存在显著差异。此外，AHI与Gensini评分（r=0.490，P<0.05）和pro-BNP（r=0.338，P<0.05）之间存在正相关。
在接受急诊pPCI的AMI患者中，SAHS患病率很高。AHI与Gensini评分和pro-BNP之间也存在正相关。因此，根据研究结果，我们是否应该对这些患者进行常规筛查，以及通过治疗SAHS是否可以减轻冠状动脉的损伤？
