Department of Internal Medicine II University Hospital Regensburg Regensburg Germany.
Clinic for General and Interventional Cardiology/Angiology Heart and Diabetes Center NRW Ruhr University Bochum Bad Oeynhausen Germany.
J Am Heart Assoc. 2021 Aug 3;10(15):e020340. doi: 10.1161/JAHA.120.020340. Epub 2021 Jul 30.
Background In patients with acute myocardial infarction (MI), cardioprotective effects of obstructive sleep apnea are postulated on account of hypoxemic preconditioning. The aim of this single-center substudy was to investigate a potential association between obstructive sleep apnea and the presence of coronary collaterals in patients with first-time acute MI who have been enrolled in an ongoing, multicenter clinical trial. Methods and Results In TEAM-ASV I (Treatment of Sleep Apnea Early After Myocardial Infarction With Adaptive Servo-Ventilation Trial; NCT02093377) patients with first acute MI who received a coronary angiogram within 24 hours after onset of symptoms underwent polygraphy within the first 3 days. Coronary collaterals were classified visually by assigning a Cohen-Rentrop Score (CRS) ranging between 0 (no collaterals) and 3. Of 94 analyzed patients, 14% had significant coronary collaterals with a CRS ≥2. Apnea-Hypopnea Index (AHI) score was significantly higher in patients with CRS ≥2 compared with those with CRS <2 (31/hour [11-54] versus 13/hour [4-27]; =0.032). A multivariable regression model revealed a significant association between obstructive AHI and CRS ≥2 that was independent of age, sex, body mass index, and culprit lesion left anterior descending artery (odds ratio [OR], 1.06; 95% CI, 1.01-1.12; =0.023), but no significant association between coronary collaterals and central AHI (OR, 1.02; 95% CI, 0.97-1.08; =0.443). Conclusions Patients with first-time acute MI had more extensive coronary collateralization with an increased AHI or rather an increased obstructive AHI. This finding supports the hypothesis that obstructive sleep apnea exerts potential cardioprotective effects, in addition to its known deleterious effects, in patients with acute MI. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02093377.
背景 在急性心肌梗死（MI）患者中，由于低氧预适应，阻塞性睡眠呼吸暂停具有心脏保护作用。本单中心子研究的目的是在一项正在进行的多中心临床试验中，调查首次急性 MI 患者中阻塞性睡眠呼吸暂停与侧支循环之间的潜在关联。
方法和结果 在 TEAM-ASV I（急性心肌梗死后早期使用适应性伺服通气治疗睡眠呼吸暂停试验；NCT02093377）中，在症状发作后 24 小时内接受冠状动脉造影的首次急性 MI 患者在发病后 3 天内进行多导睡眠图检查。通过分配 Cohen-Rentrop 评分（CRS）（范围 0[无侧支循环]至 3）来对侧支循环进行视觉分类。在分析的 94 例患者中，有 14%的患者 CRS≥2 存在显著的侧支循环。与 CRS<2 的患者相比，CRS≥2 的患者的睡眠呼吸暂停低通气指数（AHI）评分显著更高（31/小时[11-54]与 13/小时[4-27]；=0.032）。多变量回归模型显示，阻塞性 AHI 与 CRS≥2 之间存在显著关联，与年龄、性别、体重指数和罪犯病变左前降支（优势比[OR]，1.06；95%置信区间，1.01-1.12；=0.023）独立，但冠状动脉侧支循环与中心 AHI 之间无显著关联（OR，1.02；95%置信区间，0.97-1.08；=0.443）。
结论 首次急性 MI 患者的冠状动脉侧支循环更广泛，AHI 增加或阻塞性 AHI 增加。这一发现支持了这样一种假说，即在急性 MI 患者中，阻塞性睡眠呼吸暂停除了已知的有害作用外，还具有潜在的心脏保护作用。
