阻塞性睡眠呼吸暂停与肥厚型梗阻性心肌病术后心房颤动的相关性分析  

Obstructive sleep apnea is associated with postoperative atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy

作　　者：马赫赫 王生伟 任长伟[1] 韩博[1] 于建波[1] 谢菲[1] 来永强[1] MA Hehe;WANG Shengwei;REN Changwei;HAN Bo;YU Jianbo;XIE Fei;LAI Yongqiang(Cardiac Surgery Center,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心脏外科中心,100029

出　　处：《心肺血管病杂志》2021年第9期951-955,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨阻塞性睡眠呼吸暂停(OSA)与肥厚型梗阻性心肌病(HOCM)术后心房颤(POAF)的关系。方法:本研究纳入了自2019年7月,至2020年7月在安贞医院诊断进行外科手术的HOCM的患者70例,所有患者在入院后均进行睡眠呼吸监测和其他相关监测。结果:在入选的70例HOCM患者中,其中包含41(58.6%)例诊断为OSA,其中包括轻度25例,中-重度16例。合并OSA的晕厥发生率(3.4%vs.20.0%vs.31.3%,P=0.04)、FBG[(4.3±0.8)vs.(4.7±0.6)vs.(4.8±0.7)mmol/L,P=0.03]、hs-CRP水平[1.1(0.6,1.4)vs.0.8(0.1,1.7)vs.1.3(0.4,8.0)mg/L,P=0.002]等均明显较高。此外,POAF的发生率与OSA的严重程度存在明显的相关性(无,轻度,中度和重度分别为:10.3%,20.0%,56.3%(P=0.002))。在中-重度OSA患者组中,POAF发生者的呼吸暂停低通气指数(AHI)明显较高[(20.5±5.3)vs.(38.4±17.9)次/h,P=0.02]。在经年龄、性别以及BMI校正的多因素Logistre回归分析模型中,LAD(OR=1.19,95%CI:1.04~1.36,P=0.009)和AHI(OR=1.11,95%CI:1.05~1.19,P=0.001)是与HOCM患者POAF发生相关。结论:OSA的存在及严重程度是HOCM患者手术后围术期心房颤动的发生相关因素。此外,左心房直径也是这部分患者术后心房颤动的危险因素。Objective:Postoperative atrial fibrillation(POAF)is a common complication of hyper-trophic obstructive cardiomyopathy(HOCM),and it is associated with poor prognosis.The incidence rate of Obstructive sleep apnea syndrome(OSA)is relatively high in HOCM patients.There is still no research on whether there is correlation between the presence of obstructive sleep apnea and atrial fibrillation after HOCM.Therefore,the purpose of this study is to investigate the association between AF and OSA in a relatively large series of consecutive patients with HOCM.Methods:70 consecutive patients with a confirmed diagnosis of HOCM in Anzhen Hospital between July 2019 and July 2020 were included.Polysomnography were performed in all patients.Results:Among the 70 patients with hypertrophic obstructive cardiomyopathy,41(58.6%)were diagnosed as obstructive sleep apnea,including 25 mild cases and 16 moderate to severe cases.The incidences of syncope(3.4%vs.20.0%vs.31.3%,P=0.04),FBG[(4.3±0.8)vs.(4.7±0.6)vs.(4.8±0.7)mmol/L,P=0.03]and hs-CRP[1.1(0.6,1.4)vs.0.8(0.1,1.7)vs.1.3(0.4,8.0)mg/L,P=0.002]were significantly higher in patients with obstructive sleep apnea.In addition,there was a significant correlation be-tween the incidence of AF and the severity of obstructive sleep apnea(no,mild,moderate and severe were:10.3%,20.0%,56.3%(P=0.002).In patients with moderate to severe obstructive sleep apnea,the apnea hy-popnea index(AHI)was significantly higher in patients with AF[(20.5±5.3)vs.(38.4±17.9)1/h,P=0.02].In the multivariate logistic regression model adjusted for age,gender and body mass index,LAD(OR=1.19,95%CI:1.04-1.36,P=0.009)and AHI(OR=1.11,95%CI:1.05-1.19,P=0.001)were independent risk factors for postoperative AF in patients with hypertrophic obstructive cardiomyopathy.Conclu-sions:the presence and severity of obstructive sleep apnea is an independent risk factor for atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy.In addition,left atrial diameter is also a risk factor for AF in these patients.

关 键 词：肥厚型梗阻性心肌病 阻塞性睡眠呼吸暂停 术后心房颤动 

分 类 号：R54[医药卫生—心血管疾病]