探讨急性心肌梗死中睡眠呼吸暂停、心肌梗死面积和冠状动脉侧枝的关系：一项多学科研究。

IF 3 2区医学 Q2 CLINICAL NEUROLOGY

Nature and Science of Sleep Pub Date : 2025-01-09 eCollection Date: 2025-01-01 DOI:10.2147/NSS.S489788

Vaishnavi Kundel, Kavya Devarakonda, Samira Khan, Mayte Suarez-Farinas, Oren Cohen, Carlos Santos-Gallego, Mark A Menegus, Annapoorna Kini, Yuliya Vengrenyuk, Naotaka Okamoto, Hiroshi Ueda, Umesh Gidwani, Jorge R Kizer, Susan Redline, Robert Kaplan, Neomi Shah

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引用次数: 0

摘要

目的：我们设计了一项研究，探讨睡眠呼吸暂停（SA）在急性心肌梗死（AMI）患者中的心脏保护作用，重点关注其与梗死面积和冠状动脉侧支循环的关系。方法：我们招募了AMI患者，他们在住院期间接受了iii级SA检测。进行延迟增强心脏磁共振（CMR）成像以量化AMI大小（梗死心肌百分比）。Rentrop评分量化冠状动脉侧支（评分0-3分，分数越高表明侧支增强）。采用Wilcoxon秩和检验和Fisher精确检验比较Rentrop分级和梗死面积的组间差异，显著性阈值设为p。结果：33名成人中，平均年龄为54.4±11.5，平均BMI为28.4±5.9。无SA 8例（24%），有SA 25例（76%）（轻度n=10，中度n=8，重度n=7）。66% （n=22）的患者接受了CMR，所有患者均有Rentrop评分。无SA组的中位梗死面积为22%，SA组为28% （p=0.79）。虽然我们没有发现统计学上的显著差异，但中度SA有较小梗死面积的趋势(中位数15.5%；IQR为9.23)，与其他组相比(无SA [22.0%；16.8,31.8]，轻度SA [27%；23.8,32.5]，严重SA [34%；31.53, p = 0.12)。中度SA患者Rentrop分级为>0级的比例较高，且有显著性趋势（中度SA与其他组比较：62.5%对28%，p=0.08）。结论：我们的研究没有发现AMI患者的睡眠呼吸暂停严重程度对心肌梗死面积和冠状动脉侧枝的影响有统计学意义。然而，我们的结果是假设产生的，并表明中度SA可能通过增强冠状动脉侧枝提供潜在的心脏保护作用。这些发现需要未来的研究来探索缺血性预适应与SA严重程度和缺氧负担的异质性，以指导AMI患者SA管理的临床策略。

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Exploring the Relationship Between Sleep Apnea, Myocardial Infarct Size, and Coronary Collaterals in Acute Myocardial Infarction: A Multidisciplinary Study.

Purpose: We designed a study investigating the cardioprotective role of sleep apnea (SA) in patients with acute myocardial infarction (AMI), focusing on its association with infarct size and coronary collateral circulation.

Methods: We recruited adults with AMI, who underwent Level-III SA testing during hospitalization. Delayed-enhancement cardiac magnetic resonance (CMR) imaging was performed to quantify AMI size (percent-infarcted myocardium). Rentrop Score quantified coronary collateralization (scores 0-3, higher scores indicating augmented collaterals). Group differences in Rentrop grade and infarct size were compared using the Wilcoxon Rank-Sum test and Fisher's Exact test as appropriate, with a significance threshold set at p <0.05.

Results: Among 33 adults, mean age was 54.4±11.5 and mean BMI was 28.4±5.9. 8 patients (24%) had no SA, and 25 (76%) had SA (mild n=10, moderate n=8, severe n=7). 66% (n=22) underwent CMR, and all patients had Rentrop scores. Median infarct size in the no-SA group was 22% versus 28% in the SA group (p=0.79). While we did not find statistically significant differences, moderate SA had a trend toward a smaller infarct size (median 15.5%; IQR 9.23) compared to the other groups (no SA [22.0%; 16.8,31.8], mild SA [27%; 23.8,32.5], and severe SA [34%; 31.53], p=0.12). A higher proportion of moderate SA patients had a Rentrop grade >0, with a trend toward significance (moderate SA versus other groups: 62.5% versus 28%, p=0.08).

Conclusion: Our study did not find statistically significant differences in cardiac infarct size and the presence of coronary collaterals by sleep apnea severity among patients with AMI. However, our results are hypothesis-generating, and suggest that moderate SA may potentially offer cardioprotective benefits through enhanced coronary collaterals. These insights call for future research to explore the heterogeneity in ischemic preconditioning by SA severity and hypoxic burden to guide tailored clinical strategies for SA management in patients with AMI.

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来源期刊

Nature and Science of Sleep Neuroscience-Behavioral Neuroscience

CiteScore

5.70

自引率

5.90%

发文量

245

审稿时长

16 weeks

期刊介绍： Nature and Science of Sleep is an international, peer-reviewed, open access journal covering all aspects of sleep science and sleep medicine, including the neurophysiology and functions of sleep, the genetics of sleep, sleep and society, biological rhythms, dreaming, sleep disorders and therapy, and strategies to optimize healthy sleep. Specific topics covered in the journal include: The functions of sleep in humans and other animals Physiological and neurophysiological changes with sleep The genetics of sleep and sleep differences The neurotransmitters, receptors and pathways involved in controlling both sleep and wakefulness Behavioral and pharmacological interventions aimed at improving sleep, and improving wakefulness Sleep changes with development and with age Sleep and reproduction (e.g., changes across the menstrual cycle, with pregnancy and menopause) The science and nature of dreams Sleep disorders Impact of sleep and sleep disorders on health, daytime function and quality of life Sleep problems secondary to clinical disorders Interaction of society with sleep (e.g., consequences of shift work, occupational health, public health) The microbiome and sleep Chronotherapy Impact of circadian rhythms on sleep, physiology, cognition and health Mechanisms controlling circadian rhythms, centrally and peripherally Impact of circadian rhythm disruptions (including night shift work, jet lag and social jet lag) on sleep, physiology, cognition and health Behavioral and pharmacological interventions aimed at reducing adverse effects of circadian-related sleep disruption Assessment of technologies and biomarkers for measuring sleep and/or circadian rhythms Epigenetic markers of sleep or circadian disruption.