Harada Gen, Takeuchi Daiji, Inai Kei, Shinohara Tokuko, Nakanishi Toshio
1Department of Pediatric Cardiology,Tokyo Women's Medical University,Tokyo,Japan.
Cardiol Young. 2019 Jan;29(1):71-77. doi: 10.1017/S1047951118001853. Epub 2018 Nov 29.
Although sleep apnoea is an important disorder associated with cardiac events, data regarding its prevalence and risk factors in adult patients with CHD are limited.
In this study, patients underwent a sleep study in the hospital. Indications for admission were classified as heart failure, diagnostic catheterisation, interventional catheterisation, or arrhythmia. The prevalence, characteristics, and risk factors of sleep apnoea using a type 3 portable overnight polygraph in adult patients with CHD were evaluated.
This study comprised 104 patients of median age 36 years with interquartile range of 28-48 years, admitted for heart failure 34% (n = 36), diagnostic catheterisation 26% (n = 27), interventional catheterisation 18% (n = 19), or arrhythmia 22% (n = 23). The prevalence of sleep apnoea, defined as a respiratory disturbance index ≥5, was 63% (n = 63), with a distribution of 37, 16, and 10% for mild (5≤ respiratory disturbance index <15), moderate (15⩽ respiratory disturbance index <30), and severe (respiratory disturbance index ≥30) sleep apnoea, respectively. A large majority of the sleep apnoea cases were categorised as obstructive sleep apnoea (92%, n = 58). The respiratory disturbance index ≥15 group had a significantly higher proportion of male patients and higher body mass index, noradrenaline level, and aortic blood pressure than the group without sleep apnoea (respiratory disturbance index <5). Multi-variable analysis showed that NYHA class ≥II, whose odds ratio 4.36, 95% confidence interval 1.09-20.87, and body mass index ≥25, whose odds ratio 4.29, 95% confidence interval 1.32-15.23, were independent risk factors for a respiratory disturbance index ≥15.
Our results showed a high prevalence of sleep apnoea in adult patients with CHD. Its unique haemodynamics may be associated with a high prevalence of sleep apnoea. Congestive heart failure and being overweight are important risk factors for sleep apnoea. Management of heart failure and general lifestyle improvements are important for controlling sleep apnoea symptoms in these patients.
尽管睡眠呼吸暂停是一种与心脏事件相关的重要疾病，但关于其在成年冠心病患者中的患病率和危险因素的数据有限。
在本研究中，患者在医院接受了睡眠研究。入院指征分为心力衰竭、诊断性心导管检查、介入性心导管检查或心律失常。评估了成年冠心病患者使用3型便携式夜间多导睡眠图监测睡眠呼吸暂停的患病率、特征和危险因素。
本研究纳入了104例患者，中位年龄36岁，四分位间距为28 - 48岁，因心力衰竭入院的占34%（n = 36），诊断性心导管检查的占26%（n = 27），介入性心导管检查的占18%（n = 19），心律失常的占22%（n = 23）。睡眠呼吸暂停的患病率定义为呼吸紊乱指数≥5，为63%（n = 63），轻度（5≤呼吸紊乱指数<15）、中度（15≤呼吸紊乱指数<30）和重度（呼吸紊乱指数≥30）睡眠呼吸暂停的分布分别为37%、16%和10%。绝大多数睡眠呼吸暂停病例被归类为阻塞性睡眠呼吸暂停（92%，n = 58）。与无睡眠呼吸暂停（呼吸紊乱指数<5）的组相比，呼吸紊乱指数≥15的组男性患者比例显著更高，体重指数、去甲肾上腺素水平和主动脉血压也更高。多变量分析显示，纽约心脏协会（NYHA）分级≥II级，其比值比为4.36，95%置信区间为1.09 - 20.87，以及体重指数≥25，其比值比为4.29，95%置信区间为1.32 - 15.23，是呼吸紊乱指数≥15的独立危险因素。
我们的结果显示成年冠心病患者睡眠呼吸暂停的患病率很高。其独特的血流动力学可能与睡眠呼吸暂停的高患病率有关。充血性心力衰竭和超重是睡眠呼吸暂停的重要危险因素。心力衰竭的管理和总体生活方式的改善对于控制这些患者的睡眠呼吸暂停症状很重要。
