Effect of obstructive sleep apnea hypopnea syndrome on nocturnal angina in patients who undergo coronary artery bypass grafting / 中华胸心血管外科杂志

ABSTRACT

Objective:To investigate the effect and mechanism of obstructive sleep apnea hypopnea syndrome(OSAHS) on nocturnal angina in patients who undergo coronary artery bypass grafting(CABG).Methods:According to the inclusion criteria and exclusion criteria, this prospective observational study included 76 patients who underwent CABG at Beijing Anzhen Hospital affiliated to Capital Medical University from January 2018 to December 2018. Patients included 60 males and 16 females, mean aged(61.4±7.3) years, BMI(25.7±2.3) kg/m 2. Portable sleep respiration monitoring and bedside ECG monitoring were performed before surgery. According to the apnea index(AHI), patients were divided into mild or no OSAHS group(AHI<15, 35 patients) and moderate to severe OSAHS group(AHI≥15, 41 patients). Baseline data, hematologic examination, degree of coronary stenosis, sleep breathing examination, night time heart rate and incidence of atrial fibrillation, and nocturnal angina were compared between the two group. Results:Combined with mild or no OSAHS group, moderate to severe OSAHS group had a significantly higher syntax-score(47.3±10.6 vs 35.1±6.8), a significantly higher proportion of coronary diffuse lesions(53.7% vs 31.4%), a significantly faster heart rate[(94.3±21.5)times/min vs(74.8±10.0) times/min], a significantly higher proportion of nocturnal angina(29.2% vs 2.9%). The differences were statistically significant( P<0.05). Binary logistic regression analysis showed that the fastest heart rate at night significantly affected the occurrence of nocturnal angina in CABG patients( OR=1.320, 95% CI: 1.084-1.607, P=0.006), the syntax-score, the fastest heart rate at night significantly affected the degree of OSAHS in CABG patients( OR=1.269, 95% CI: 1.094-1.473, P=0.002; OR=1.066, 95% CI: 1.004-1.131, P=0.036). Two linear regression showed a significant linear correlation between AHI with the fastest heart rate and syntax-score at night( R2=0.576, P<0.001; R2=0.658, P<0.001). Conclusion:OSAHS can significantly aggravate the degree of coronary artery stenosis in CABG patients, and further increase the incidence of nocturnal angina by significantly increasing nighttime heart rate.