急性冠状动脉综合征中阻塞性睡眠呼吸暂停的表型特征。

IF 2.2 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Heart, Lung and Circulation Pub Date : 2024-12-01 Epub Date: 2024-10-11 DOI:10.1016/j.hlc.2024.07.014
Benjamin K Tong, Seren Ucak, Hasthi Dissanayake, Sanjay Patel, Glenn M Stewart, Kate Sutherland, Brendon J Yee, Usaid Allahwala, Ravinay Bhindi, Philip de Chazal, Peter A Cistulli
{"title":"急性冠状动脉综合征中阻塞性睡眠呼吸暂停的表型特征。","authors":"Benjamin K Tong, Seren Ucak, Hasthi Dissanayake, Sanjay Patel, Glenn M Stewart, Kate Sutherland, Brendon J Yee, Usaid Allahwala, Ravinay Bhindi, Philip de Chazal, Peter A Cistulli","doi":"10.1016/j.hlc.2024.07.014","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Recent neutral randomised clinical trials have created clinical equipoise for treating obstructive sleep apnoea (OSA) for managing cardiovascular risk. The importance of defining the links between OSA and cardiovascular disease is needed with the aim of advancing the robustness of future clinical trials. We aimed to define the clinical correlates and characterise surrogate cardiovascular markers in patients with acute coronary syndrome (ACS) and OSA.</p><p><strong>Method: </strong>Overall, 66 patients diagnosed with ACS were studied. Patients underwent an unattended polysomnogram after hospital discharge (median [interquartile range] 62 [37-132] days). The Epworth Sleepiness Scale, Berlin, and STOP-BANG questionnaires were administered. Surrogate measures of vascular structure and function, and cardiovascular autonomic function were conducted. Pulse wave amplitude drop was derived from the pulse oximetry signals of the overnight polysomnogram.</p><p><strong>Results: </strong>OSA (apnoea-hypopnea index [AHI] ≥5) was diagnosed in 94% of patients. Moderate-to-severe OSA (AHI≥15) was observed in 68% of patients. Daytime sleepiness (Epworth Sleepiness Scale ≥10) was reported in 17% of patients. OSA screening questionnaires were inadequate to identify moderate-to-severe OSA, with an area under the receiver operating characteristic curve of approximately 0.64. Arterial stiffness (carotid-femoral pulse wave velocity, 6.1 [5.2-6.8] vs 7.4 [6.6-8.6] m/s, p=0.002) and carotid intima-media thickness (0.8 [0.7-1.0] vs 0.9 [0.8-1.0] mm, p=0.027) was elevated in patients with moderate-to-severe OSA. After adjusting for age, sex and body mass index, these relationships were not statistically significant. No relationships were observed in other surrogate cardiovascular markers.</p><p><strong>Conclusions: </strong>A high prevalence of OSA in a mostly non-sleepy population with ACS was identified, highlighting a gross underdiagnosis of OSA among cardiovascular patients. The limitations of OSA screening questionnaires highlight the need for new models of OSA screening as part of cardiovascular risk management. A range of inconsistent abnormalities were observed in measures of vascular structure and function, and these appear to be largely explained by confounding factors. Further research is required to elucidate biomarkers for the presence and impact of OSA in ACS patients.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":"1648-1658"},"PeriodicalIF":2.2000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Phenotypic Characterisation of Obstructive Sleep Apnoea in Acute Coronary Syndrome.\",\"authors\":\"Benjamin K Tong, Seren Ucak, Hasthi Dissanayake, Sanjay Patel, Glenn M Stewart, Kate Sutherland, Brendon J Yee, Usaid Allahwala, Ravinay Bhindi, Philip de Chazal, Peter A Cistulli\",\"doi\":\"10.1016/j.hlc.2024.07.014\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Recent neutral randomised clinical trials have created clinical equipoise for treating obstructive sleep apnoea (OSA) for managing cardiovascular risk. The importance of defining the links between OSA and cardiovascular disease is needed with the aim of advancing the robustness of future clinical trials. We aimed to define the clinical correlates and characterise surrogate cardiovascular markers in patients with acute coronary syndrome (ACS) and OSA.</p><p><strong>Method: </strong>Overall, 66 patients diagnosed with ACS were studied. Patients underwent an unattended polysomnogram after hospital discharge (median [interquartile range] 62 [37-132] days). The Epworth Sleepiness Scale, Berlin, and STOP-BANG questionnaires were administered. Surrogate measures of vascular structure and function, and cardiovascular autonomic function were conducted. Pulse wave amplitude drop was derived from the pulse oximetry signals of the overnight polysomnogram.</p><p><strong>Results: </strong>OSA (apnoea-hypopnea index [AHI] ≥5) was diagnosed in 94% of patients. Moderate-to-severe OSA (AHI≥15) was observed in 68% of patients. Daytime sleepiness (Epworth Sleepiness Scale ≥10) was reported in 17% of patients. OSA screening questionnaires were inadequate to identify moderate-to-severe OSA, with an area under the receiver operating characteristic curve of approximately 0.64. Arterial stiffness (carotid-femoral pulse wave velocity, 6.1 [5.2-6.8] vs 7.4 [6.6-8.6] m/s, p=0.002) and carotid intima-media thickness (0.8 [0.7-1.0] vs 0.9 [0.8-1.0] mm, p=0.027) was elevated in patients with moderate-to-severe OSA. After adjusting for age, sex and body mass index, these relationships were not statistically significant. No relationships were observed in other surrogate cardiovascular markers.</p><p><strong>Conclusions: </strong>A high prevalence of OSA in a mostly non-sleepy population with ACS was identified, highlighting a gross underdiagnosis of OSA among cardiovascular patients. The limitations of OSA screening questionnaires highlight the need for new models of OSA screening as part of cardiovascular risk management. A range of inconsistent abnormalities were observed in measures of vascular structure and function, and these appear to be largely explained by confounding factors. Further research is required to elucidate biomarkers for the presence and impact of OSA in ACS patients.</p>\",\"PeriodicalId\":13000,\"journal\":{\"name\":\"Heart, Lung and Circulation\",\"volume\":\" \",\"pages\":\"1648-1658\"},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2024-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Heart, Lung and Circulation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.hlc.2024.07.014\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/10/11 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart, Lung and Circulation","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.hlc.2024.07.014","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/11 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0

摘要

背景:最近的中性随机临床试验为治疗阻塞性睡眠呼吸暂停(OSA)以控制心血管风险提供了临床依据。需要明确 OSA 与心血管疾病之间的联系,以提高未来临床试验的稳健性。我们旨在确定急性冠状动脉综合征(ACS)和 OSA 患者的临床相关性和代用心血管标志物的特征:方法:共对 66 名确诊为急性冠状动脉综合征(ACS)的患者进行了研究。患者在出院后(中位数[四分位间差]62[37-132]天)接受了无人值守的多导睡眠图检查。对患者进行了爱普沃斯嗜睡量表、柏林和 STOP-BANG 问卷调查。对血管结构和功能以及心血管自主神经功能进行了替代测量。脉搏波振幅下降是从通宵多导睡眠图的脉搏血氧仪信号中得出的:94%的患者被诊断为 OSA(呼吸暂停-低通气指数 [AHI] ≥5)。68%的患者被诊断为中重度 OSA(AHI≥15)。17%的患者出现白天嗜睡(埃普沃斯嗜睡量表≥10)。OSA筛查问卷不足以识别中重度OSA,接收者工作特征曲线下面积约为0.64。动脉僵化(颈动脉-股动脉脉搏波速度,6.1 [5.2-6.8] vs 7.4 [6.6-8.6] m/s,p=0.002)和颈动脉内膜厚度(0.8 [0.7-1.0] vs 0.9 [0.8-1.0] mm,p=0.027)在中度至重度 OSA 患者中有所升高。在对年龄、性别和体重指数进行调整后,这些关系没有统计学意义。其他代用心血管标志物也没有发现任何关系:结论:在大多数非睡眠人群中,发现患有 ACS 的 OSA 患病率很高,这表明心血管疾病患者中 OSA 的诊断率严重不足。OSA筛查问卷的局限性凸显了作为心血管风险管理一部分的OSA筛查新模式的必要性。在对血管结构和功能的测量中观察到了一系列不一致的异常,而这些异常似乎在很大程度上是由干扰因素造成的。还需要进一步的研究来阐明 ACS 患者中是否存在 OSA 及其影响的生物标志物。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Phenotypic Characterisation of Obstructive Sleep Apnoea in Acute Coronary Syndrome.

Background: Recent neutral randomised clinical trials have created clinical equipoise for treating obstructive sleep apnoea (OSA) for managing cardiovascular risk. The importance of defining the links between OSA and cardiovascular disease is needed with the aim of advancing the robustness of future clinical trials. We aimed to define the clinical correlates and characterise surrogate cardiovascular markers in patients with acute coronary syndrome (ACS) and OSA.

Method: Overall, 66 patients diagnosed with ACS were studied. Patients underwent an unattended polysomnogram after hospital discharge (median [interquartile range] 62 [37-132] days). The Epworth Sleepiness Scale, Berlin, and STOP-BANG questionnaires were administered. Surrogate measures of vascular structure and function, and cardiovascular autonomic function were conducted. Pulse wave amplitude drop was derived from the pulse oximetry signals of the overnight polysomnogram.

Results: OSA (apnoea-hypopnea index [AHI] ≥5) was diagnosed in 94% of patients. Moderate-to-severe OSA (AHI≥15) was observed in 68% of patients. Daytime sleepiness (Epworth Sleepiness Scale ≥10) was reported in 17% of patients. OSA screening questionnaires were inadequate to identify moderate-to-severe OSA, with an area under the receiver operating characteristic curve of approximately 0.64. Arterial stiffness (carotid-femoral pulse wave velocity, 6.1 [5.2-6.8] vs 7.4 [6.6-8.6] m/s, p=0.002) and carotid intima-media thickness (0.8 [0.7-1.0] vs 0.9 [0.8-1.0] mm, p=0.027) was elevated in patients with moderate-to-severe OSA. After adjusting for age, sex and body mass index, these relationships were not statistically significant. No relationships were observed in other surrogate cardiovascular markers.

Conclusions: A high prevalence of OSA in a mostly non-sleepy population with ACS was identified, highlighting a gross underdiagnosis of OSA among cardiovascular patients. The limitations of OSA screening questionnaires highlight the need for new models of OSA screening as part of cardiovascular risk management. A range of inconsistent abnormalities were observed in measures of vascular structure and function, and these appear to be largely explained by confounding factors. Further research is required to elucidate biomarkers for the presence and impact of OSA in ACS patients.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Heart, Lung and Circulation
Heart, Lung and Circulation CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
4.50
自引率
3.80%
发文量
912
审稿时长
11.9 weeks
期刊介绍: Heart, Lung and Circulation publishes articles integrating clinical and research activities in the fields of basic cardiovascular science, clinical cardiology and cardiac surgery, with a focus on emerging issues in cardiovascular disease. The journal promotes multidisciplinary dialogue between cardiologists, cardiothoracic surgeons, cardio-pulmonary physicians and cardiovascular scientists.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信