| Objective:Obstructive sleep apnea hypopnea syndrome(OSAHS) is a common sleep-related breathing disorders.This study was designed to observe the level changes of plasma high-sensitivity C-reactive protein(hs-CRP), fibrinogen(Fbg) in varying degrees of OSAHS patients with coronary heart disease before and after two months regular continuous positive airway pressure(CPAP) treatment, so as to investigate the clinical significance of OSAHS and its interventions in the occurrence and development process of coronary heart disease. This study also observed in patients with coronary heart disease combined with hypertension, mainly focus on the changes in24h ambulatory blood pressure and heart rate variability before and after two months regular CPAP treatment. By exploring the clinical significance of OSAHS and its intervention in patients with coronary heart disease and high blood pressure, we are looking forward to provide the theoretical basis in the secondary prevention of coronary heart disease and hypertension.Methods:(1) We selected93cases of coronary heart disease continuously and randomly, they are all diagnosed by coronary angiography at least one coronary artery stenosis≥50%between December2012and July2013in our hospital, all eligible patients had a clear night sleep snoring. Patients receive overnight polysomnographic sleep monitoring after admitted to hospital, and patients will be divided into three groups according to test results:19cases of group①:CHD patients with mild OSAHS group,44cases of group②:CHD patients with moderate or severe OSAHS group, and30cases of group③:simple CHD group. Simultaneously gruoped again38patients in group①and group②with hypertension,17cases of group②:CHD&HBP combined with OSAHS-conventional treatment group,21cases of group⑤:CHD&HBP combined with OSAHS-CPAP treatment group, another group of patients are20patients selected in group③, they are composed pf group⑥:control group.(2) Selected patients in group①-③were admitted to fasting venous blood in the morning, hs-CRP was measured by nephelometry, Fbg measured by coagulation, and at the same time measuring blood routine, routine blood clotting and blood lipids, fasting glucose, liver and kidney function and other biochemical markers. Patients in group①-③can choose whether they are treated with CPAP according to their own wishes. Patients in group④-⑥were carried out24h ABPM and Holter, and was recorded numbers of relevant indicators. Patients in group④and group⑥control their coronary heart disease and hypertension with conventional drugs and intervention, while patients in group⑤conduct a period of two months of CPAP treatment on the basis of conventional therapy.(3)45patients in group①-③that clearly associated with OSAHS and accepted CPAP treatment were followed up for two months, and detect the level of hs-CRP and Fbg again in the morning after treatment of the last night. Patients who received only conventional treatment also come to hospital and review the two indexes. Patients in group④-⑥accept24h ABPM and Holter again after two months of treatment.(4) Using SPSS17.0statistical software for data analysis.Results:(1) There is no significant difference in gender, age, smoking, blood lipids, blood pressure, blood sugar, liver and kidney function and other indicators of patients in group①-③, while patients in group②with a body mass index significantly higher than the other two groups. There is also no significant difference in gender, age, smoking, body mass index, blood lipids, blood pressure, blood sugar, liver and kidney function and other indicators of patients in group④-⑥.(2) The hs-CRP and Fbg level difference was statistically significant in patients in group①-③before treatment. For further pairwise comparison, patients in group②have statistically significant higher plasma hs-CRP and Fbg levels,while patients in group①also have higher plasma hs-CRP and Fbg levels but without any statistically significance.(3) There are totally45cases completed CPAP treatment in group①-③, in patients combined with mild OSAHS, plasma hs-CRP, Fbg levels decreased slightly after treatment but no significant statistical difference, while in patients combined with moderate or severe OSAHS, we can see a significant statistical difference in both indexes.(4)There are totally18cases who are clearly associated with OSAHS but only willing to take conventional drugs in group①and group②, their hs-CRP and Fbg levels did not change significantly after two months treatment, in the group of patients②we even see slightly elevated hs-CRP.(5) Patients with OSAHS have a higher nMSBP and nMDBP, increased incidence of EMBPS and non-dipper blood pressure, increasing the proportion of combined antihypertensive drugs, and heart rate variability reduce.(6) After two months of treatment, patients in group⑤24 hMSBP, nMSBP, nMDBP down significantly, the incidence of EMBPS reduce, some patients recover dipper, and combination therapy also improved, SDNN, PNN50rebounded significantly. The remaining patients have no significant changes.Conclusions:(1) Patients combined with OSAHS and CHD can present of active inflammation and coagulation abnormalities, and this abnormalities may increase with the exacerbation of OSAHS. This may be an important factor in promoting the development of coronary heart disease, we may observed in patients with serum hs-CRP and Fbg changing situation in favor of the combined risk of coronary heart disease was found earlier.(2) Effective CPAP therapy can improve the clinical symptoms, reduce the inflammatory response in vivo, elimination of thrombophilia and hypercoagulable state, may reduce in patients with acute coronary artery events occur after stent implantation, which may have some value in disease progression, guide treatment and prognosis, and provide a reliable basis for the secondary prevention of coronary heart disease.(3) OSAHS increased blood pressure in hypertensive patients with coronary heart disease, destruct of circadian rhythm, and increase the types and doses of combination therapy.(4) OSAHS reduce heart rate variability in patients with hypertension combined with coronary heart disease.(5) Effective CPAP therapy can improve patients’ circadian rhythm, increase heart rate variability, reduce the type and dose of antihypertensive drugs in combination, and helps to reduce risk factors in patients with coronary heart disease and hypertension. |
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