Study On The Correlation Between Obstructive Sleep Apnea And Right Heart Function In Patients With Coronary Heart Disease

Objective: To explore the correlation between obstructive sleep apnea and right heart function in patients with coronary heart disease。Method: 248 patients with coronary heart disease who were hospitalized in the cardiovascular ward of the Fourth Affiliated Hospital of China Medical University from July 2018 to June 2019 were continuously enrolled.The patients’ general clinical and fasting laboratory data,coronary angiography,sleep monitoring,and echocardiography reports were collected.According to whether patients have obstructive sleep apnea(OSA),divide them into non-obstructive sleep apnea(NOSA)group and OSA group,and the general clinical data and right heart function indicators between the two groups were statistically analyzed.Furthermore,OSA patients were categorized into three groups: mild OSA,moderate OSA,and severe OSA based on the level of apnea hypopnea index(AHI),and the right heart function parameters were analyzed as subgroups.Results:1.There were 57 patients in the NOSA group,consisting of 38 men,aged on average(60.6710.56)years.191 patients made up the OSA group,including 144 males,with an average age of(64.57±11.70)years.In the two groups,there was no statistical change in the general clinical data(P>0.05).2.The left ventricular end-systolic volume(ESV)was higher in the OSA group than in the NOSA group,but the rate of change in right ventricular area(RVFAC)was lower than that in the NOSA group,and there was statistically significant difference(P<0.05).On the contrary,there were no significant differences in left atrial diameter(LAD),left ventricular diameter(LVD),left ventricular end-diastolic volume(EDV),left ventricular ejection fraction(LVEF),right ventricular diameter(RVD),tricuspid annulus systolic velocity(TVS’),and tricuspid annular systolic displacement(TAPSE)between the two groups(P>0.05).3.Subgroup analysis: Individuals with OSA were further separated into three groups: 54 cases with mild OSA,66 with moderate OSA,and 71 with severe OSA.The proportion of smokers in the severe OSA group was higher than that in the mild OSA group(P<0.05),and creatinine(CREA)in the severe OSA group was significantly higher than that in the mild OSA group and the moderate OSA group(P<0.05).The LVEF,RVFAC and TVS’ in the group with severe OSA were significantly lower than those in the mild OSA group(P<0.05),and the LAD and ESV in the group with severe OSA was substantially higher than in the group with mild OSA(P<0.05).LVEF and TVS’ were significantly lower in the severe OSA group than in the moderate OSA group(P<0.05).4.According to whether AHI is greater than 15 events per hour,patients were categorized into two groups: NOSA and mild OSA group,moderate to severe OSA group.The results of logistic univariate and multivariate regression analysis showed that RVFAC was independently correlated with moderate to severe OSA(P <0.05).5.The ROC curve with RVFAC as the predictor and moderate to severe OSA as the outcome variable showed the area under the RVFAC curve of 0.619(95% CI: 0.550-0.688,P=0.001),indicating that RVFAC had predictive value for moderate to severe OSA.Conclusion:In people with coronary heart disease,right ventricular function is reduced in OSA patients and more pronounced in patients with severe OSA.RVFAC is independently correlated with moderate to severe OSA and has predictive value for moderate to severe OSA.