Department of Angiology, Faculty of Health Sciences, Medical University in Wroclaw, Wroclaw, Poland.
Fourth Military Teaching Hospital in Wroclaw, Wroclaw, Poland.
Adv Exp Med Biol. 2019;1211:69-75. doi: 10.1007/5584_2019_397.
Obstructive sleep apnea (OSA) is a common disease affecting about 13% of men and 6% of women, usually having severe cardiovascular sequalae. OSA is responsible for the systemic inflammatory response and oxidative stress and results in endothelial injury being a risk factor for atherosclerosis. The aim of this study was to estimate the prevalence of OSA among patients with severe carotid artery stenosis. Fifty-five patients (F/M-24/31, mean age 70 ± 7 years, body mass index 28.3 ± 6.3 kg/m) were enrolled into the study. The patients were qualified for elective surgical treatment of carotid artery stenosis. Polysomnography was performed in all patients the night before surgery. Thirty-six patients underwent surgical endarterectomy and nineteen patients underwent carotid artery stenting. Sleep apnea was diagnosed in 44 (80%) of all patients. The mean apnea-hypopnea index (AHI) was 14.5 ± 12.9. The OSA severity distribution was as follows: 22 mild, 16 moderate, and 6 severe cases. We found that the percentage of carotid endarterectomies was the greatest in mild and moderate OSA. It was approximately twofold greater than that in non-OSA patients. Carotid artery stenting was performed in nearly half of the patients in each of these groups. We conclude that OSA is highly prevalent in patients with carotid artery stenosis scheduled for carotid surgery. Nonetheless, the exact pathogenetic mechanisms underlying mutual interaction between OSA and vascular wall damage remain elusive. OSA is not routinely diagnosed among patients with advanced atherosclerosis. The study results might be an argument for performing polysomnography in patients with carotid artery stenosis.
阻塞性睡眠呼吸暂停（OSA）是一种常见疾病，影响约 13%的男性和 6%的女性，通常伴有严重的心血管后果。OSA 导致全身炎症反应和氧化应激，导致内皮损伤，成为动脉粥样硬化的危险因素。本研究旨在评估严重颈动脉狭窄患者中 OSA 的患病率。55 名患者（男/女 24/31，平均年龄 70±7 岁，体重指数 28.3±6.3kg/m²）被纳入研究。这些患者符合颈动脉狭窄择期手术治疗的条件。所有患者均在手术前一晚进行多导睡眠图检查。36 名患者接受了手术颈动脉内膜切除术，19 名患者接受了颈动脉支架置入术。所有患者均诊断为睡眠呼吸暂停。平均呼吸暂停低通气指数（AHI）为 14.5±12.9。OSA 严重程度分布如下：22 例轻度、16 例中度和 6 例重度。我们发现，在轻度和中度 OSA 患者中，颈动脉内膜切除术的比例最大。这比非 OSA 患者高出约两倍。在这些组中的每一组中，近一半的患者接受了颈动脉支架置入术。我们得出结论，OSA 在接受颈动脉手术的颈动脉狭窄患者中患病率很高。尽管如此，OSA 与血管壁损伤之间相互作用的确切发病机制仍不清楚。OSA 并未在进展性动脉粥样硬化患者中常规诊断。研究结果可能支持对颈动脉狭窄患者进行多导睡眠图检查。
