Association Between Severity Of Sleep Apnea And Severity Of Coronary Artery Disease In Hypertensive Patients With OSAHS

ObjectiveTo explore the association between the severity of sleep apnea and the severity of coronary artery disease in patients with hypertension(HTN)and obstructive sleep apnea hypopnea syndrome(OSAHS),and risk factors for coronary artery lesions that may be caused by OSAHS.MethodRetrospective case comparative analysis was selected in this study select adult patients treated in Taizhou People’s Hospital from 2021-2022 that accepted Polysomnography(PSG),and exclude patients with recently identified infection and elevated temperature;Other sleep disorders such as central sleep apnea syndrome;Patients with chronic obstructive pulmonary disease,chronic bronchitis,pulmonary tuberculosis and other diseases causing abnormal lung function;Patients who have received OSAHS-related treatments such as CPAP or surgical procedures;Patients with mental disorders who cannot cooperate with relevant examinations;Patients with severe liver or kidney dysfunction;Patients with chronic inflammatory(chronic consumptive)diseases;Patients with affected blood counts as a result of medication or illness;Patients with endocrine diseases such as hyperthyroidism,hypothyroidism,pheochromocytoma;Patients allergic to contrast media(iopromide);Patients with severe bleeding tendencies;Patients with congenital heart disease;Patients who have previously implanted coronary stents;Patients with NYHA grade Ⅲ or Ⅳ;Patients with acute cardiovascular and cerebrovascular accidents;Pregnant or lactating women.According to the sleep apnea hypopnea index(AHI),the patients was divided into Simple Hypertension Group(AHI≤5),Hypertension With Mild to Moderate OSAHS Group(5<AHI<30)and Hypertension With Severe OSAHS Group(AHI ≥ 30).The minimum sample size with statistical significance was calculated according to the statistical method,50 patients in each group have been determined.Collect the clinical characteristics of the selected patients,including gender,age,height,weight,smoking and drinking history,NYHA cardiac function rating.The medical history data of the selected patients were collected,including hypertension,coronary heart disease,diabetes,hemorrhagic disease history,and treatment methods during hospitalization.The polysomnography results of the selected patients were collected,including hypoxemia index,minimum and average blood oxygen saturation,and AHI.Collect the results of coronary artery CTA examination or percutaneous coronary angiography of the selected patients,and score the stenosis degree of different coronary artery branches according to the Gensini method developed by the American Heart Association.Collect the laboratory blood test indicators of all the selected patients on the day of hospitalization or the next morning,including total bilirubin(TBiL),alanine aminotransferase(ALT),alanine aminotransferase(ALP),glutamyl transpeptidase(GGT),creatinine(CREA),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),serum total cholesterol(TC),triglyceride(TG)concentration,homocysteine(Hcy),peripheral count of white blood cell(WBC),red blood cell(RBC),hemoglobin(Hb)concentration and other indicators.The differences of Gensini score,blood examination result and PSG parameters among groups were compared.Results1.Compared with the simple hypertension group,the Gensini score in the hypertension with OSAHS group was significantly increased(P <0.05),and was positively correlated with the AHI course(r=0.556,P <0.05).2.In patients with hypertension and OSAHS,the level of Hcy increased,and was positively correlated with AHI(r=0.382,P <0.001).3.In patients with hypertension and OSAHS,the level of CRP increased,and was positively correlated with AHI(r=0.448,P <0.001).Conclusion1.The degree of coronary artery disease in patients with hypertension and OSAHS was higher than that in patients with hypertension alone,and was positively correlated with the severity of OSAHS.2.High Hcy levels in patients with hypertension combined with OSAHS may related to the occurrence and progression of coronary artery disease.3.CRP increases in patients with hypertension combined with OSAHS,and is significantly higher than that in patients with simple hypertension,suggesting that such patients have a higher level of inflammation,which may related to the occurrence and progression of coronary artery lesions.