Çakır Emirhan, Özkan Uğur, Yılmam İlker
Department of Cardiology, School of Medicine, Trakya University, 22030 Edirne, Turkey.
Department of Pulmonology, School of Medicine, Trakya University, 22030 Edirne, Turkey.
Medicina (Kaunas). 2025 Sep 15;61(9):1674. doi: 10.3390/medicina61091674.
: Obstructive sleep apnea syndrome (OSAS) and heart failure (HF) frequently coexist, amplifying cardiovascular risk through mechanisms involving chronic inflammation and autonomic dysfunction. This study investigates the impact of systemic inflammation, measured by the systemic immune-inflammation index (SII), and OSAS severity, assessed by the apnea-hypopnea index (AHI), on myocardial repolarization heterogeneity in patients with both conditions. : In this retrospective study, 160 patients with HF and polysomnography-confirmed OSAS (AHI ≥ 5 events/h) were evaluated between January 2018 and November 2024. Patients were stratified by QT dispersion (QTd < 40 ms vs. ≥40 ms) to assess electrical heterogeneity. SII was calculated from neutrophil, platelet, and lymphocyte counts, and electrocardiographic markers (QTd, frontal QRS-T angle, T wave peak-to-end interval [TPEI]) were measured. Logistic regression and receiver operating characteristic (ROC) analyses were used to identify predictors of repolarization heterogeneity and ventricular arrhythmias. : Patients with QTd ≥ 40 ms ( = 78) exhibited higher SII ( < 0.001) and AHI ( < 0.001) compared to those with QTd < 40 ms ( = 82). SII and AHI independently predicted increased QTd in multivariate analysis ( = 0.01 and < 0.001, respectively). ROC analysis identified SII ≥ 625.4 (sensitivity 73.1%, specificity 72%) and AHI ≥ 22.4 (sensitivity 79.5%, specificity 79.3%) as optimal cut-offs for predicting repolarization heterogeneity. SII, QTd, and TPEI were significantly associated with ventricular arrhythmias ( < 0.05). Patients with moderate-to-severe OSAS (AHI ≥ 15) had higher rates of ventricular tachyarrhythmias (17.8% vs. 5.7%, = 0.03) and sudden cardiac death (9.3% vs. 1.9%, = 0.05). : Elevated SII and AHI are independent predictors of myocardial repolarization heterogeneity in patients with HF and OSAS, contributing to increased arrhythmic risk. These findings highlight the potential use of SII and AHI as accessible biomarkers for risk stratification, particularly in patients with a preserved ejection fraction, and underscore the need for targeted interventions to mitigate inflammation and OSAS severity.
阻塞性睡眠呼吸暂停综合征（OSAS）与心力衰竭（HF）常并存，通过涉及慢性炎症和自主神经功能障碍的机制增加心血管风险。本研究调查了用全身免疫炎症指数（SII）衡量的全身炎症以及用呼吸暂停低通气指数（AHI）评估的OSAS严重程度对这两种疾病患者心肌复极异质性的影响。：在这项回顾性研究中，对2018年1月至2024年11月期间的160例HF且多导睡眠图确诊为OSAS（AHI≥5次/小时）的患者进行了评估。根据QT离散度（QTd<40ms与≥40ms）对患者进行分层，以评估电异质性。根据中性粒细胞、血小板和淋巴细胞计数计算SII，并测量心电图指标（QTd、额面QRS-T角、T波峰末间期[TPEI]）。采用逻辑回归和受试者工作特征（ROC）分析来确定复极异质性和室性心律失常的预测因素。：与QTd<40ms（n=82）的患者相比，QTd≥40ms（n=78）的患者表现出更高的SII（P<0.001）和AHI（P<0.001）。在多变量分析中，SII和AHI独立预测QTd增加（分别为P=0.01和P<0.001）。ROC分析确定SII≥625.4（敏感性73.1%，特异性72%）和AHI≥22.4（敏感性79.5%，特异性79.3%）为预测复极异质性的最佳截断值。SII、QTd和TPEI与室性心律失常显著相关（P<0.05）。中重度OSAS（AHI≥15）患者的室性快速心律失常发生率（17.8%对5.7%，P=0.03）和心源性猝死发生率（9.3%对1.9%，P=0.05）更高。：SII和AHI升高是HF和OSAS患者心肌复极异质性的独立预测因素，导致心律失常风险增加。这些发现突出了SII和AHI作为可及的生物标志物用于风险分层的潜在用途，特别是在射血分数保留的患者中，并强调了需要采取针对性干预措施来减轻炎症和OSAS严重程度。
