阻塞性睡眠呼吸暂停与冠状动脉旁路移植术后心脏复极的时间变化。

Obstructive sleep apnea and temporal changes in cardiac repolarization in patients undergoing coronary artery bypass grafting.

机构信息

Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore.

出版信息

J Clin Sleep Med. 2024 Jan 1;20(1):49-55. doi: 10.5664/jcsm.10786.

DOI:10.5664/jcsm.10786

PMID:38163943

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10758550/

Abstract

STUDY OBJECTIVES

In coronary artery bypass grafting (CABG), abnormal cardiac repolarization is associated with adverse cardiovascular events that can be measured via the QTc interval. We investigated the impact of obstructive sleep apnea on the change in repolarization after CABG and the association of change in repolarization with the occurrence of major adverse cardiac and cerebrovascular events.

METHODS

A total of 1,007 patients from 4 hospitals underwent an overnight sleep study prior to a nonemergent CABG. Electrocardiograms of 954 patients (median age: 62 years; male: 86%; mean follow-up: 2.1 years) were acquired prospectively within 48 hours before CABG (T1) and within 24 hours after CABG (T2). QTc intervals were measured using the BRAVO algorithm by Analyzing Medical Parameters for Solutions LLC. The change in T2 from T1 for QTc (ΔQTc) was derived, and Cox regression was performed.

RESULTS

Compared with those without, patients who developed major adverse cardiac and cerebrovascular events (n = 115) were older and had (1) a higher prevalence of smoking, hypertension, diabetes mellitus, and chronic kidney disease; (2) a higher apnea-hypopnea index and oxygen desaturation index; and (3) a smaller ΔQTc. Cox regression analysis demonstrated a smaller ΔQTc to be an independent risk factor for major adverse cardiac and cerebrovascular events (hazard ratio: 0.997; = .032). In the multivariable regression model, a higher oxygen desaturation index was independently associated with a smaller ΔQTc (correlation coefficient: -0.58; < .001).

CONCLUSIONS

A higher preoperative oxygen desaturation index was an independent predictor of a smaller ΔQTc. ΔQTc within 24 hours after CABG could be a novel predictor of occurrence of major adverse cardiac and cerebrovascular events at medium-term follow-up.

CLINICAL TRIAL REGISTRATION

Registry: ClinicalTrials.gov; Name: Undiagnosed Sleep Apnea and Bypass OperaTion (SABOT); URL: https://classic.clinicaltrials.gov/ct2/show/NCT02701504; Identifier: NCT02701504.

CITATION

Teo YH, Yong CL, Ou YH, et al. Obstructive sleep apnea and temporal changes in cardiac repolarization in patients undergoing coronary artery bypass grafting. . 2024;20(1):49-55.

摘要

研究目的

在冠状动脉旁路移植术（CABG）中，异常的心脏复极与心血管不良事件相关，这些事件可以通过 QTc 间期来测量。我们研究了阻塞性睡眠呼吸暂停对 CABG 后复极变化的影响，以及复极变化与主要不良心脏和脑血管事件发生的相关性。

方法

来自 4 家医院的 1007 例患者在非紧急 CABG 术前进行了一夜睡眠研究。954 例患者（中位年龄：62 岁；男性：86%；平均随访：2.1 年）的心电图在 CABG 前 48 小时内（T1）和 CABG 后 24 小时内（T2）前瞻性采集。使用 Analyzing Medical Parameters for Solutions LLC 的 BRAVO 算法测量 QTc 间期。从 T1 到 T2 的 QTc（ΔQTc）变化值通过 Cox 回归分析得出。

结果

与未发生主要不良心脏和脑血管事件的患者（n=115）相比，发生该事件的患者年龄更大，并且（1）吸烟、高血压、糖尿病和慢性肾脏病的患病率更高；（2）呼吸暂停低通气指数和氧减指数更高；（3）ΔQTc 更小。Cox 回归分析表明，ΔQTc 较小是主要不良心脏和脑血管事件的独立危险因素（风险比：0.997；P=0.032）。在多变量回归模型中，较高的氧减指数与较小的 ΔQTc 独立相关（相关系数：-0.58；P<0.001）。

结论

术前较高的氧减指数是 ΔQTc 较小的独立预测因子。CABG 后 24 小时内的 ΔQTc 可能是中期随访时主要不良心脏和脑血管事件发生的新预测因子。

临床试验注册

注册号：ClinicalTrials.gov；名称：未确诊的睡眠呼吸暂停和旁路手术（SABOT）；网址：https://classic.clinicaltrials.gov/ct2/show/NCT02701504；标识符：NCT02701504。

引用

Teo YH, Yong CL, Ou YH, et al. Obstructive sleep apnea and temporal changes in cardiac repolarization in patients undergoing coronary artery bypass grafting.. 2024;20(1):49-55.