Farha Kassar, Gercek Mustafa, Gercek Muhammed, Mischlinger Johannes, Rudolph Volker, Gummert Jan F, Saad Charbel, Aboud Anas, Fox Henrik
Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
Clinic for Cardiovascular Surgery, Herzzentrum Duisburg, Duisburg, Germany.
J Sleep Res. 2024 Oct;33(5):e14181. doi: 10.1111/jsr.14181. Epub 2024 Feb 26.
Sleep-disordered breathing is common in patients with coronary artery disease undergoing coronary artery bypass grafting. Sleep-disordered breathing is associated with increased perioperative morbidity, arrhythmias (e.g. atrial fibrillation) and mortality. This study investigated the impact of sleep-disordered breathing on the postoperative course after coronary artery bypass grafting, including development of atrial fibrillation. This prospective single-centre cohort study included adults undergoing coronary artery bypass grafting. All were screened for sleep-disordered breathing (polygraphy) and atrial fibrillation (electrocardiogram) preoperatively; those with known sleep-disordered breathing or atrial fibrillation were excluded. Endpoints included new-onset atrial fibrillation, duration of mechanical ventilation, time in the intensive care unit, and postoperative infection. Regression analysis was performed to identify associations between sleep-disordered breathing and these outcomes. A total of 508 participants were included (80% male, median age 68 years). The prevalence of any (apnea-hypopnea index ≥ 5 per hr), moderate (apnea-hypopnea index = 15-30 per hr) and severe (apnea-hypopnea index > 30 per hr) sleep-disordered breathing was 52.9%, 9.3% and 10.2%, respectively. All-cause 30-day mortality was 0.98%. After adjustment for age and sex, severe sleep-disordered breathing was associated with longer respiratory ventilation support (crude odds ratio [95% confidence interval] 5.28 [2.18-12.77]; p < 0.001) and higher postoperative infection rates (crude odds ratio 3.32 [1.45-7.58]; p < 0.005), but not new-onset atrial fibrillation or mortality. New-onset atrial fibrillation was significantly associated with postoperative infection and prolonged hospital stay. The significant associations between sleep-disordered breathing and several adverse outcomes after coronary artery bypass grafting support the need for preoperative sleep-disordered breathing screening in individuals undergoing cardiac surgery.
睡眠呼吸紊乱在接受冠状动脉旁路移植术的冠心病患者中很常见。睡眠呼吸紊乱与围手术期发病率增加、心律失常（如心房颤动）及死亡率相关。本研究调查了睡眠呼吸紊乱对冠状动脉旁路移植术后病程的影响，包括心房颤动的发生情况。这项前瞻性单中心队列研究纳入了接受冠状动脉旁路移植术的成年人。术前所有患者均接受睡眠呼吸紊乱（多导睡眠图）及心房颤动（心电图）筛查；已知有睡眠呼吸紊乱或心房颤动的患者被排除。观察终点包括新发心房颤动、机械通气时间、重症监护病房停留时间及术后感染。进行回归分析以确定睡眠呼吸紊乱与这些结局之间的关联。共纳入508名参与者（80%为男性，中位年龄68岁）。任何程度（呼吸暂停低通气指数≥5次/小时）、中度（呼吸暂停低通气指数=15 - 30次/小时）及重度（呼吸暂停低通气指数>30次/小时）睡眠呼吸紊乱的患病率分别为５２.９%、９.３%及１０.２%。全因30天死亡率为０.９８%。在调整年龄和性别后，重度睡眠呼吸紊乱与更长时间的呼吸通气支持相关（粗比值比[95%置信区间]5.28[2.18 - 12.77]；p<0.001）及更高的术后感染率（粗比值比3.32[1.45 - 7.58]；p<0.005），但与新发心房颤动或死亡率无关。新发心房颤动与术后感染及住院时间延长显著相关。冠状动脉旁路移植术后睡眠呼吸紊乱与多种不良结局之间的显著关联支持了对接受心脏手术的个体进行术前睡眠呼吸紊乱筛查的必要性。
