在急性冠状动脉综合征中阻断性睡眠呼吸暂停的表型特征
Benjamin K Tong1, Seren Ucak2, Hasthi Dissanayake2
1Sleep Research Group, Charles Perkins Centre and Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, NSW, Australia.
Heart, lung & circulation
|October 12, 2024
概括
阻塞性睡眠呼吸暂停 (OSA) 在急性冠状动脉综合征 (ACS) 患者中非常普遍,通常未被诊断出来. 目前的查工具不足,需要新的心血管风险管理方法.
科学领域:
- 心脏病学 心脏病学
- 睡眠医学 睡眠医学
- 血管生物学 血管生物学
背景情况:
- 阻塞性睡眠呼吸暂停 (OSA) 越来越被认为是心血管风险管理的一个重要因素.
- 对于减轻心血管风险的OSA最佳治疗,存在临床均衡.
- 了解OSA和心血管疾病之间的关系对于推进临床试验设计至关重要.
研究的目的:
- 确定急性冠状动脉综合征 (ACS) 患者中OSA的临床相关物.
- 在患有OSA的ACS患者中特征代用心血管标志物.
- 在这个人群中评估OSA查问卷的诊断性能.
主要方法:
- 66名患有ACS的患者在出院后接受了多睡眠学.
- 进行了标准化问卷调查 (爱普沃思睡眠度量表,柏林,STOP-BANG).
- 用替代标记物评估血管结构,功能和自主功能,包括脉冲波分析.
主要成果:
- 在ACS患者中发现OSA (94%) 和中度至重度OSA (68%) 的高患病率.
- 仅有17%的患者报告白天嗜睡,这表明大部分人群无症状.
- 在OSA查问卷中,对于识别中度至重度OSA的准确性有限 (AUC~0.64).
- 在中度至重的OSA中观察到动脉硬度升高和动脉内膜-介质厚度升高,但在同变量调整后,在统计学上并不显著.
结论:
- 相当大比例的ACS患者没有被诊断为OSA,这突显了心血管保健中的关键差距.
- 现有的OSA查问卷对于ACS患者的有效风险分层是不够的.
- 需要进一步的研究来确定可靠的生物标志物来确定OSA存在及其在ACS中的心血管影响.
- 新的OSA查策略对于全面的心血管风险管理至关重要.
相关概念视频
Acute Coronary SyndromeI: Introduction
3
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
3
Sleep Apnea
130
Sleep apnea is a condition where breathing stops intermittently during sleep, often leading to significant health issues. Each episode can last from 10 to 20 seconds or more and is frequently accompanied by a brief arousal from sleep. This disturbance, largely unnoticed by the individual, can lead to severe daytime fatigue. Commonly, individuals seek help after being informed by their partners about loud snoring and noticeable breathing pauses during sleep.
The condition is more prevalent among...
The condition is more prevalent among...
130
Acute Coronary Syndrome III: Diagnostic studies
3
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
3
Acute Coronary Syndrome II: Pathophysiology and clinical manifestations
3
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
3
Acute Respiratory Failure-IV
129
Respiratory failure can manifest suddenly or gradually, characterized by a rapid decline in PaO2 and a rapid rise in PaCO2. This situation indicates a severe respiratory problem that may quickly become a life-threatening emergency. One of the early signs of hypoxemic Acute Respiratory Failure (ARF) is a change in mental status due to the brain's sensitivity to oxygen levels and changes in acid-base balance. Symptoms such as restlessness, confusion, and agitation suggest inadequate oxygen...
129
Acute Coronary Syndrome V: Nursing Management
2
Nursing Assessment:Nursing management of acute coronary syndrome (ACS) involves taking the patient's history, focusing on primary complaints such as chest pain, dyspnea, and excessive sweating (diaphoresis), as well as other symptoms like back or jaw pain, nausea, vomiting, palpitations, dizziness, and fatigue. The nurse also reviews the patient's history of cardiac events, risk factors such as hypertension, diabetes, smoking, family history, and current medications.In the objective assessment,...
2


