The Clinical Study On The Relation Between Obstructive Sleep Apnea-hyponea Syndrome And Acute Myocardial Infarction

Objective Obstructive sleep apnea-hyponea syndrome(OSAHS) is the most clinically common type of Sleep-related breathing disorders,which may act to cause and promote hypertension,coronary artery disease,acute myocardial infarction(AMI) and cerebral vascular disease.The objective of this experiment is to observe the prevalence rate of OSAHS in patients with ST segment elevation myocardial infarction(STEMI) and approach the correlation between OSAHS and in AMI and how OSAHS influence the prognosis of patients with AMI in order to search a new idea for the treatment of patients with AMI.Methods The total of 75 patients,admitted in our intensive care unit,were included randomly in the study from March 2007 to December 2008,which were diagnosed as STEMI and performed coronary angiography and overnight oximetry.According to primary diagnostic criteria developed by Sleep Breathing Study Group of Respiratory Diseases Branch of Chinese Medical Association, the patients were divided into two groups:AMI associated OSAHS (AMI+OSAHS) group,33 patients;AMI without complications group,42 patients. We recorded the duration from onset of symptom to admission.The numbers of lesions of coronary artery and Gensini Score for assessing the severity of coronary atherosclerosis were made in both groups.Serum levels of the peak of Creatine kinase(CK),high-sensitivity C-reactive protein(hs-CRP),N-terminal Pro-Brain natriuretic peptide(NT-proBNP) were investigated.Left ventricular ejection fraction(LVEF) and left ventricle end-diastolic volume index(LVEDVI) were assessed by echocardiography.Overnight oximetry recordings for detection of OSAS were performed in all patients.They were divided into three groups based on their oxyhemoglobin desaturation index(ODI) detected by examination of overnight oximetry,mild OSAHS group(10 events/h＜ODI＜20 events/h,16cases), moderate-to-severe group(AHI＞20 events/h,17cases)and control group(AHI＜10 events/h,42cases).Linear regression was performed to assess ODI and Gensini Score.Mutiple logistic regression analysis was performed to assess LVEF and hs-CRP,NT-proBNP and OSAHS.Results(1) The prevalence of OSAHS in patients with AMI was high, reached 44 percent.The prevalence of hypertension in patients with AMI was higher than those with no OSAHS,which was significantly different in both group(p=0.04);(2) From midnight to 6 a.m.,AMI occurred in 39.4 percent of people with obstructive sleep apnea,as compared with 11.9 percent of people without obstructive sleep apnea(p=0.0057).From 6 a.m.to noon,the frequency of AMI was significantly lower in persons with obstructive sleep apnea than in persons without obstructive sleep apnea(15.2 percent vs.49.2 percent; p＝0.0098).We similarly analyzed AMI during three time intervals that correlate with usual sleep-wake cycles(10 p.m.to 6 a.m.,6 a.m.to 2 p.m.,and 2 p.m.to 10 a.m.).From 10 p.m.to 6 a.m.,AMI occurred in 45.5 percent of people with obstructive sleep apnea,as compared with 16.7 percent of people without obstructive sleep apnea(p=0.0066).From 6 a.m.to 2 p.m.,AMI occurred in 24.2 percent of people with obstructive sleep apnea,as compared with 52.3 percent of people without obstructive sleep apnea(p=0.0135).;(3) Compared with the control group,the levels of the peak of CK,hs-CRP,NT-proBNP and LVEDVI were significantly increased(p=0.0084,p=0.004,p=0.036,p=0.02),the level of LVEF were significantly decreased(p=0.0091);The incidence of no-reflow phenomenon and ventricular tachycardia/ventricular fibrillation was significantly increased(p=0.037,p=0.0295);The percentage of patients with multi-coronary vessel disease[36.4%(12/33)]was significantly increased,compared with the control group[14.3%(6/42)](p=0.0263);(4) left ventricular function:Compared with the non-OSAHS group,the levels of hs-CRP,NT-proBNP was significantly increased in the mild,moderate-to-severe OSAHS group,the level of LVEF were significantly decreased.Compared with the mild OSAHS group,the levels of the peak of CK,hs-CRP,NT-proBNP and LVEDVI were significantly increased and the level of LVEF were significantly decreased in the moderate-to-severe OSAHS group(p＜0.01).(4) regression analysis:There was a significant positive correlation between ODI and Gensini Score(r=0.873,p=0.000).In multiple logistic regression model,the serum levels of the peak of CK,hs-CRP, NT-proBNP and OSAHS were independently associated with left ventricular dysfunction,and the risk of left ventricular dysfunction in AMI patients with OSAHS is 5.78 times than that in patients without OSAHS after emendating the risk factors such as age,hypertension and smoking(p=0.008,95%CI 1.76-21.34).Conclusion OSAHS is associated with high AMI morbidity,and patients with the combination of DSA and AMI are at higher risk for hypertension.People with OSAHS have a peak in AMI during the sleeping hours,which contrasts strikingly with the nadir of A MI during this period in people without OSAHS and in the general population.Compared with the non-OSAHS group,the percentage of patients with multi-coronary-vessel disease was significantly increased,and the level of LVEF significantly decreased There was a significant positive correlation between ODI and Gensini Score in the OSAHS group.OSAHS were independently associated with left ventricular dysfunction(LVEF＜50%),and the risk of left ventricular dysfunction in AMI patients with OSAHS is 5.78 times than that in patients without OSAHS.