Hội chứng ngưng thở khi ngủ dạng tắc nghẽn ở người có bệnh tim thiếu máu cục bộ

1 Survey the relationship between the apnea - hyponea index and neck circumference, waist circumference, BMI, blood pressure, blood lipid parameters, SpO2 and Gensini score... Evaluate

Reporter: Dr Nguyen Nhat Quang

BACKGROUND

Evaluate the frequency, clinical and preclinical characterization of obstructive sleep apnea syndrome in patients with ischemic heart disease

1

Survey the relationship between the apnea - hyponea index and neck circumference, waist circumference, BMI, blood pressure, blood lipid parameters, SpO2 and Gensini score

2

Diagnostic criteria

 Criteria A : excessive daytime sleepiness

 Criteria B : ≥ 2 following criteria

1 Gasping and choking sensations

2 More frequent arousals

3 Insomnia

4 Daytime fatigue

5 Memory and intellectual impairment

 Criteria C : AHI ≥ 5 events/h

OSA = Cr A and/or Cr B + Cr C

The severity of OSAS

 Mild: AHI = 5 – 15 events/h

 Moderate: AHI =16 – 30 events/h

 Heavy: AHI > 30 events/h

2 METHODS AND SUBJECTS

2.1 SUBJECTS

Criteria for patient selection :

 ≥ 50% stenosis of coronary arteries and

suspected evidence of obstructive sleep apnea

2 METHODS AND SUBJECTS

• Severe heart failure (EF <30%)

• Central sleep apnea syndrome

• Not agree to collaborate with the research

2.2 Time of research

02/2012 – 07/2014

2.3 Methods

Cross-sectional descriptive study

2 METHODS AND SUBJECTS

1.General characteristic

Diabetes mellitus Age

BMI Neck circumference Waist circumference

The study progress

2 Survey on clinical characteristic

Apnea (có người chứng kiến)

Loud snore (có người chứng kiến)

Gasping and/or choking sensations

Excessive daytime sleep

More frequent arousals

Insomnia

Morning headache

Memory and intellectual impairment

The study progress

3 Survey on subclinical characteristic

3.1 Glucose, bilan lipid máu

3.2 Coronary angiography

Evaluate the abnormality of coronary artery

• Determine the number of coronary artery lesions:

Based on the image on the light screen

• Determine the extent of stenosis:

0: not narrow

1: not flat vessel wall but not narrow diameter

2: no significant narrowing the diameter stenosis <50% 3: a narrow sense to narrow diameter from 50-75%

4: closed narrow when diameter stenosis > 75-95%

5: very closed narrow almost the entire diameter of > 100%, together with congestion of contrast before

95-narrowing position

6: occlusion

Gensini score = Total score of the number of lesions

multiplicated with the factor

The position of coronary lesions and factor of lesions in accordance with Gensini score

TIMI SCALE

TIMI Characteristic

3

The contrast flows freely and absorbed rapidly in front

of and behind the lesion of the coronary artery

2

The contrast is over the lesion to distal more slowly and be ale to see the flow in the coronary artery lumen, still fills the coronary arteries.

1

Only a small amount of contrast isbthrough the lesion

to the distal but not fill up the artery, slowly.

0 No the contrast is through the lesion to the distal of

coronary artery (occlusion or non-recovery).

The study progress

3.3 Polysomnography

 Patients were included in the explorative room on the appropriate time according to each patient's habits, then they were fixed in Respironics Stardust

II of the Respironics company (Germany), including the measuring device of SpO2, nasal airflow, respiratory muscle pressure measuring of chest and abdomen, snoring index, posture

 Patients will be removed the device on the next morning when they wake up.

SLEEP EXPLORATION UNIT

STARDUST II DEVICE

 Mean SpO2 and lowest SpO2

 The nocturnal desaturation index

 Snore index

3 RESULT AND DISCUSSION

The prevalence of OSAS

• Our study: 80/119 pts with IHD and OSAS (67,22%)

• Konecny T et al: study of 74 patients with acute coronary syndrome showed that the prevalence of OSAS is 69%

• Mooe T et al:

 142 male pts with IHD: 37% pts have AHI ≥ 10 events/h

 226 pts with angina: 52,7% pts have OSAS

• Peker Y et al: Study of 62 pts showed that the lower prevalence of OSAS is 30,6%

The age of subjects

0 10 20 30 40 50 60

 Mean age of OSAS group: 63,9 ± 11,84 ys

 Mean age of non-OSAS group: 60,85 ± 11,07 ys

 Peker Y.: 71,5 ± 12,1 and 67,8 ± 9,7 (p>0,05)

 LU Gan: 55,58 ± 8,68 and 57,63 ± 9,86

The gender of subiects

Gender

OSAS (+) (n = 80)

OSAS (-) (n = 39) Total p

n % n % n %

Male 51 65,4 27 34,6 78 100,0

> 0,05 Female 29 70,7 12 29,3 41 100,0

- Chi Hang Lee: most of pts in both two groups were male (98,6% and 97,2%)

- Peker Y.: the similar result (78,9% and 67,4%) with p>0,05

Neck circumference (NC)

Body

measurement

OSAS (+) (n = 80)

OSAS (-) (n = 39) p

Waist circumference (WC)

Body

measurement

OSA S (+) (n = 80)

OSA S (-) (n = 39) p

WC (cm) 83,12 ± 4,70 81,03 ± 3,42 > 0,05

- LU Gan: Mean WC of moderate-heavy and mild OSAS group were 95,71 ± 8,84 (cm) and 93,20 ± 7,24 (cm) The mild OSAS had bigger mean WC than that in non-OSAS group (p<0,01)

BMI

Body

measurement

OSA S (+) (n = 80)

OSA S (-) (n = 39) p

Risk factors

Risk factors

OSA S (+) (n = 80)

OSA S (-) (n = 39) p

The meta-analysis in OR of risk factors

in two groups of patients

The patients with overweight/obesity are likely to get OSAS

higher than 3,7 times compared with the normal people

Functional symptoms of OSAS

Functional symptom

OSAS (+) (n = 80)

OSAS (-) (n = 39) Total p

• Le Thuong Vu: snore (92%), daytime sleepiness (65,8%)

• Goksan B: the prevalence of pts with morning headache in OSAS group > non-OSAS group (33,6% > 8,9%, p<0,05)

Functional symptoms of OSAS

Functional symptom

OSAS (+) (n = 80)

OSAS (-) (n = 39) Total p

Distribution of severity of OSAS

Toatal time (minute) X ± SD 457,76±50,90 453,25±28,01 > 0,05

- LU Gan: no significant diference of mean SpO2

between two group of pts, median value of lowest

SpO2 in OSAS group < non-OSAS group (86,5%<90%,

p<0,001)

Distribution of coronary artery flow

in accordance with the TIMI scale

TIMI OSA (+) OSA (-) Total p

TIMI 0 18 62,1 11 37,9 29

> 0,05 TIMI 1 19 63,3 11 36,7 30

Distribution of severity of coronary lesions in

accordance with Gensini score

Gensini

score

OSA (+) (n = 80)

OSA (-) (n = 39) Total

Distribution of Gensini score

in accordance with the severity of OSAS

Hayashi M: Mean Gensini score was increased in accordance with AHI and mean value of OSAS group (31,7± 13,6 và 37,2

± 22,7) > non-OSAS group (21,3 ± 17,1) (p<0,05)

Distribution of Gensini score

in accordance with the severity of OSAS

The correlation between AHI and

The correlation between AHI and BMI

The correlation between AHI

The correlation between AHI and Sp02

The correlation between AHI

and Gensini score

The regression equation between

Gensini score and AHI, TIMI

CONCLUSION

The incidence of patients with ischemic heart disease that have OSAS in our study was 67.22%

CONCLUSION

Clinical characteristics:

 Mean age: 63,90 ± 11,84 ys and no significant difference

in age between two groups of pts

 Mean BMI in OSAS group is higher than in non-OSAS group (p <0,05) Pts who are overweight, obese are likely

to develop OSAS 3,7 times higher than the normal person (95% CI: 1,211 – 11,391, p = 0,022)

 Snoring accounted for the majority (64/119 patients) Of

these, 81,3% of patients have OSAS

 The rate of snoring, morning headaches, excessive daytime sleepiness and decreased concentration-related memory in OSAS group is much higher than in non-OSAS group (p <0,05)

 No significant difference in median value ​​of SBP and DBP between two groups of patients (p> 0,05)

 Median value of the nocturnal oxygen desaturation index in OSAS group is larger than in non-OSAS group (p <0,05)

 Median value of lowest Sp02 in OSAS group is smaller than in non-OSAS group (p <0,001)

 A significant difference of median value of Gensini score among three severity of OSAS (p <0,001)

RECOMMENDATION

OSAS are common in pts with IHD and the severity of this syndrome has tightly positive correlation with the degree of coronary artery lesions So, screening for OSAS in pts with IHD

is essential It helps guide to manage risk factors

atherosclerosis, prevent the cardiovascular events that can be occur