Eur J Cardiovasc Nurs. 2021 Mar 1;20(3):202–211. doi: 10.1177/1474515120941373.
Focusing on detection of sleep apnoea early in the cardiac rehabilitation process may improve the recovery process and reduce recurrence of cardiovascular events. Patients who continue to be undiagnosed may experience a significantly worse outcome during their cardiac rehabilitation and recovery. Diastolic dysfunction has both diagnostic and prognostic importance in the management of coronary artery disease. We hypothesise that undiagnosed/untreated sleep apnoea in middle-aged coronary artery disease patients with preserved left ventricular ejection fraction changes the pattern of diastolic filling close to that in elderly patients without sleep apnoea.
This cross-sectional study included the 450 coronary artery disease patients with undiagnosed sleep apnoea who had left ventricular ejection fraction ⩾50% and were referred consecutively to the Clinic of Cardiovascular Rehabilitation within two weeks after treatment for acute coronary syndrome. Polysomnographic and echocardiographic measurements were analysed. Mild to severe sleep apnoea was defined as the apnoea-hypopnea index ⩾5. Age was dichotomised into under the age of 60 years and age 60 years or over. Up to 35% of coronary artery disease patients were likely to have undiagnosed sleep apnoea. There was a statistically significant interaction between the effect of sleep apnoea and age group on diastolic function defined as the ratio peak flow velocity in early diastole/peak flow velocity in atrial contraction ratio (p=0.036). This ratio was significantly (p=0.029) lower in the mild-severe sleep apnoea group (0.97, 95% confidence interval 0.88-1.06) than in the non-sleep apnoea group (1.09, 95% confidence interval 1.03-1.15) among middle aged (<60 years) coronary artery disease patients. Therefore, filling patterns in the middle aged (<60 years) patients with sleep apnoea resemble those observed in the elderly (⩾60 years) patients without sleep apnoea. The effect of sleep apnoea on left ventricular filling pattern in elderly was not observed.
Age modifies the effect of sleep apnoea on cardiovascular outcomes. The findings that undiagnosed sleep apnoea impairs diastolic function in a middle-aged coronary artery disease patient underscore the importance of early diagnosis and treatment of sleep apnoea. It is recommended to train and educate cardiac rehabilitation staff on the importance of sleep disorders in this population.
在心脏康复过程中早期关注睡眠呼吸暂停的检测，可能有助于改善康复过程并降低心血管事件的复发率。那些持续未被诊断的患者在心脏康复和恢复过程中可能会经历显著更差的结果。舒张功能障碍在冠心病的管理中具有诊断和预后的重要性。我们假设，在左心室射血分数保留的中年冠心病患者中，如果未诊断和/或未治疗睡眠呼吸暂停，会改变舒张期充盈模式，使其接近无睡眠呼吸暂停的老年患者。
这项横断面研究纳入了 450 例经连续治疗急性冠状动脉综合征后两周内被转诊至心血管康复诊所且左心室射血分数 ⩾50%的未诊断睡眠呼吸暂停的冠心病患者。分析了多导睡眠图和超声心动图测量结果。轻度至重度睡眠呼吸暂停定义为呼吸暂停低通气指数 ⩾5。年龄分为 60 岁以下和 60 岁或以上。多达 35%的冠心病患者可能存在未诊断的睡眠呼吸暂停。睡眠呼吸暂停和年龄组对舒张功能的影响之间存在统计学显著的交互作用，舒张功能定义为舒张早期峰值流速/心房收缩峰值流速比（p=0.036）。在中年（<60 岁）冠心病患者中，轻度至重度睡眠呼吸暂停组的比值显著（p=0.029）低于无睡眠呼吸暂停组（0.97，95%置信区间 0.88-1.06）（1.09，95%置信区间 1.03-1.15）。因此，患有睡眠呼吸暂停的中年（<60 岁）患者的充盈模式类似于无睡眠呼吸暂停的老年（⩾60 岁）患者。在老年患者中，未观察到睡眠呼吸暂停对左心室充盈模式的影响。
年龄改变了睡眠呼吸暂停对心血管结局的影响。未诊断的睡眠呼吸暂停会损害中年冠心病患者的舒张功能，这强调了早期诊断和治疗睡眠呼吸暂停的重要性。建议对心脏康复工作人员进行培训和教育，使其了解该人群中睡眠障碍的重要性。
