本文選題：阻塞性睡眠呼吸暫停 + 冠心病　； 參考：《首都醫(yī)科大學(xué)》2017年博士論文

【摘要】：目的:阻塞性睡眠呼吸暫停(Obstructive sleep apnea,OSA)是一種臨床常見的睡眠障礙類疾病,已有研究支持睡眠呼吸暫停與冠心病之間存在密切關(guān)系。但目前關(guān)于OSA與急性冠脈綜合征(acute coronary syndrome,ACS)患者相關(guān)研究較少。本研究旨在評估阻塞性睡眠呼吸暫停對接受經(jīng)皮冠狀動脈介入治療(percutaneous coronary intervention,PCI)后ACS患者的病變嚴重程度(如射血分數(shù)、SYNTAX評分、住院時間等)和長期預(yù)后(主要不良心血管事件Major Adverse Cardiovascular Events,MACE)的影響。方法:本研究為單中心前瞻性隊列研究,選擇2012年12月至2015年12月于首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院心內(nèi)科住院并行冠狀動脈介入治療的患者,嚴格按照入排標準最終共納入患者579例。所有患者均行冠脈造影檢查和/或冠脈介入治療及多導(dǎo)睡眠圖(Polysomnography,PSG)檢查,根據(jù)睡眠呼吸監(jiān)測結(jié)果將睡眠呼吸暫停低通氣指數(shù)(apnea-hypopnea index,AHI)≤15次/小時作為對照組,AHI15次/小時為中重度OSA組。比較兩組患者ACS嚴重程度(疾病診斷分型、SYNTAX評分、射血分數(shù)以及住院時間),對兩組患者進行隨訪并記錄MACE事件(心源性死亡、非致命性心肌梗死、靶血管再次血運重建、再次發(fā)作心絞痛、因心衰發(fā)作住院治療)比較長期預(yù)后差異。結(jié)果:最終進行隨訪并納入分析529名患者(50例失訪),156例患者AHI≤15次/小時,373例患者AHI15次/小時。中重度OSA患者組評價AHI為37.2±16.9,而對照組為9.4±3.4。與對照組相比,中重度OSA組男性患者所占比例(79.9%vs 69.2%,P=0.008)和高血壓患病率較高(75.3%vs 64.1%,P=0.009),同時合并有較高的體重指數(shù)(BMI)(28.1±3.6 vs 26.4±3.4,P0.001)和Epworth評分(6.2±5.4 vs 4.5±3.9,P0.001)。中重度OSA組多支血管病變患者的比例(28.2%vs 10.3%,P0.001)、SYNTAX評分(10.1±10.0 vs 3.0±6.4,P0.001)和住院天數(shù)(8.0±5.6 vs 6.7±4.2,P=0.007)較高,同時合并較低的射血分數(shù)(61.8±8.3 vs 63.8±6.8,P=0.009)。中位隨訪時間為28±4.6個月,中重度OSA組事件發(fā)生率顯著高于對照組(8.6%vs 3.2%,P=0.028)。在矯正了年齡、性別等混雜因素后顯示中重度OSA組發(fā)生不良事件的風(fēng)險增加(HR=2.758,95%CI1.068-7.122,P=0.036)。結(jié)論:中重度OSA組患者ACS嚴重程度更高,常合并更加復(fù)雜的冠狀動脈病變,對ACS患者PCI術(shù)后長期事件發(fā)生率有不良的影響,中重度OSA是不良心血管事件發(fā)生的獨立危險因素。
[Abstract]:Objective: obstructive sleep apnea (OSA) is one of the most common sleep disorders, and has been studied to support the close relationship between sleep apnea and coronary heart disease.However, there are few studies on the relationship between OSA and acute coronary syndrome (ACS).The purpose of this study was to evaluate the severity of obstructive sleep apnea (OSAS) in patients with ACS after percutaneous coronary intervention (PCI), such as ejection fraction (EPS).Duration of hospitalization and long-term prognosis (major adverse cardiovascular events Major Adverse Cardiovascular events).Methods: this study was a single center prospective cohort study. Patients admitted to Beijing Anzhen Hospital from December 2012 to December 2015 with coronary intervention were enrolled in the study.A total of 579 patients were included according to the admission criteria.All patients underwent coronary angiography and / or coronary intervention and polysomnography (PSG).According to the results of sleep respiration monitoring, the apnea hypopnea index (apnea-hypopnea index) 鈮，

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