The coexistence of obstructive sleep apnea in patients with slow coronary flow: a cross-sectional study

Yıl 2020, Cilt: 2 Sayı: 4, 112 - 116, 23.09.2020

Arslan Ocal , Ersin Saricam , Nihal Basay Gulcın Sarıyıldız

https://doi.org/10.38053/acmj.753838

Öz

BACKGROUND: Interestingly, obstructive sleep apnea (OSA) and coronary slow-flow (CSF) have similar pathogenic mechanisms, including increased sympathetic activity and endothelial dysfunction. However, the association between OSA and CSF is not known well. If undiagnosed, OSA is a cause of increased cardiovascular morbidity and mortality. We investigated the presence of OSA in the patients diagnosed CSF after coronary angiography.
METHODS: The prospective cross-sectional study included 4515 patients admitted angiography laboratory from February 2018 to March December 2019. After coronary angiography of 4515 patients, 336 patients were diagnosed as slow coronary flow. These patients were examined by pulmonology and sleep specialist. Of the 336 patients, 276 patients were found high risk in terms of OSA by using Berlin questionnaire (BQ). Only 75 of 276 patients underwent polysomnography (PSG) testing. Control group patients (n=40) had normal coronary artery and no OSA.
RESULTS: Of 4515 patients, 336 (7.4%) met the criteria for CSF. After BQ, 276 of 336 patients had high-score BQ (82.1%). The study group consisted of 276 patients (188 males, 88 females). The mean ages of the study group were 48.48 ±7.61 years. Body mass index (BMI) according to WHO criteria was 33.02±2.18 kg/m2. When 75 patients underwent PSG were divided on two groups as mild OSA and moderate/severe OSA according to respiratory disturbance index (RDI). We found a significant positive correlation between mean corrected TIMI Frame Count (CTFC) and RDI. While CTFC-Lad in mild OSA group was 32.73, CTFC-Lad in moderate/severe OSA group was 35.04 (p=0.022). While CTFC-Cx in mild OSA group was 31.67, CTFC-Cx in moderate/severe OSA group was 35.26 (p=0.001). While CTFC-Rca in mild OSA group was 32.57, CTFC-Rca in moderate/severe OSA group was 36.33 (p<0.001).
CONCLUSION: This study revealed the coexistence between CSF and OSA. Moreover, we demonstrated a significant relationship between mean CTFC and RDI. To determine the clinical association of OSA and CSF may be help to understand pathophysiology of CSF.

Anahtar Kelimeler

Coronary slow flow, Obstructive sleep apnea

Koroner yavaş akım hastalarında obstrüktif uyku apnesi birlikteliği: Kesitsel çalışma

Öz

Amaç: Obstrüktif uyku apnesi (OUA) ve koroner yavaş akım (KYA) ilginç olarak artmış sempatik aktivite ve endotelyal disfonksiyon gibi benzer patolojik mekanizmalara sahiptir. Fakat OUA ve KYA arasındaki birliktelik çok iyi bilinmemektedir. Eğer tanı konmazsa, OUA artmış kardiyovasküler mortalite ve morbidite nedenlerinden biridir. Biz bu çalışmada koroner anjiyografi sonrası KYA tanısı almış hastalarda OUA varlığını araştırdık.
Gereç ve Yöntem: Bu prospektif kesitsel çalışma Şubat 2018-Aralık 2019 yılları arası anjiyografiye alınan 4515 hastayı kapsamaktadır. Koroner anjiyografi sonrası 4515 hastanın 336 sına YKA tanısı konmuştur. Bu 336 hastanın 276 sı Berlin anket bulgularına göre yüksek riskli olarak bulunmuştur. Çalışma grubu 276 hastadan oluşmaktaydı. Bu hastalardan 75 ine polisomnografi testi yapılmıştır. Kontrol grubu (40 hasta) normal koroner arterli ve OUA olmayan hastalardı.
Bulgular: 4515 hastanın 336 sı KYA tanısı almıştı (%7.4). Berlin anket çalışması sonrası 336 hastanın 276 sı yüksek risk grubu idi (%82.1). Çalışma grubu 188 erkek, 88 kadından oluşmaktaydı (toplam 276 hasta). Ortalama yaş 48.48 ±7.61 yıl idi. Vücut kitle indeksi 33.02±2.18 kg/m2 idi. Polisomnografi yapılan 75 hasta solunum bozukluk indeksine göre hafif ve orta/ağır derece olarak iki gruba ayrılmıştır. Biz solunum bozukluk indeksi ve düzeltilmiş TIMI sayımı arasında pozitif ilişki saptadık. Hafif grupta CTFC-Lad değeri 32.73, orta/ağır grupta CTFC-Lad değeri 35.04 (p=0.022). Hafif grupta CTFC-Cx değeri 31.67, orta/ağır grupta CTFC-Cx değeri 35.26 (p=0.001). Hafif grupta CTFC-Rca değeri 32.57, orta/ağır CTFC-Rca değeri 36.33 (p<0.001).
Sonuç: Bu çalışma OUA ve KYA arasında birliktelik olduğunu ortaya koymuştur. İlave olarak biz solunum bozukluk indeksi ile ortalama düzeltilmiş TIMI sayımı arasında anlamlı ilişkiyi gösterdik. OUA ve KYA birlikteliğinin saptanması KYA ın patofizyolojisini anlamada yardımcı olur.

Anahtar Kelimeler

koroner yavaş akım, obstrüktif uyku apnesi

Kaynakça

• Referans1 Beltrame JF. Defining the coronary slow flow phenomenon. Circ J 2012; 76:818-20
• Referans2 Gibson CM, Cannon CP, Daley WL, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation 1996; 93:879-88.
• Referans3 Hawkins BM, Stavrakis S, Rousan TA, Abu-Fadel M, Schechter E. Coronary slow flow--prevalence and clinical correlations. Circ J. 2012; 76(4): 936–942.
• Referans4 Caples SM, Gami AS, Somers VK. Obstructive sleep apnea. Ann Intern Med 2005;142: 187–197.
• Referans5 Lee W, Nagubadi S, Kryger MH, Mokhlesi B. Epidemiology of Obstructive Sleep Apnea: a Population-based Perspective. Expert Rev Respir Med. 2008 1; 2(3): 349–364.
• Referans6 Punjabi NM, Caffo BS, Goodwin JL, Gottlieb DJ, Newman AB, O'Connor GT, Rapoport DM, Redline S, Resnick HE, Robbins JA, Shahar E, Unruh ML, Samet JM. Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med. 2009; 6(8):e1000132.
• Referans7 Somers VK, White DP, Amin R, et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. J Am Coll Cardiol 2008; 52:686–717.
• Referans8 Varadharaj S, Porter K, Pleister A, Wannemacher J, Sow A, Jarjoura D, Zweier JL, Khayat RN. Endothelial Nitric Oxide Synthase Uncoupling: A Novel Pathway in OSA Induced Vascular Endothelial Dysfunction. Respir Physiol Neurobiol. 2015 Feb 1;0: 40–47.
• Referans9 Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999; 131:485–491.
• Referans10 Sateia M.J. International Classification of Sleep Disorders-Third Edition Highlights and Modifications. Chest 2014; 146 (5): 1387– 1394.
• Referans 11 Kushida CA, Littner MR, Morgenthaler T, et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep. 2005; 28(4):499–521.
• Referans12 Pekdemir H, Polat G, Cin VG, et al. Elevated plasma endothelin-1 levels in coronary sinus during rapid right atrial pacing in pa¬tients with slow coronary flow. Int J Cardiol. 2004; 97(1): 35–41.
• Referans13 Signori LU, Quadros AS, Sbruzzi G, et al. Endothelial function in patients with slow coronary flow and normal coronary angi¬ography. Clinics (Sao Paulo). 2012; 67(6): 677–680.
• Referans14 Somers VK, Mark AL, Zavala DC, Abboud FM. Influence of ventilation and hypocapnia on sympathetic nerve responses to hypoxia in normal humans. J Appl Physiol (1985). 1989; 67 (5):2095 – 2100.
• Referans15 Somers VK, Dyken ME, Clary MP, Abboud FM. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest. 1995; 96 (4):1897 – 1904.
• Referans16 Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2017;13(3):479-504.
• Referans17 Pereira EJ, Driver HS, Stewart SC, Fitzpatrick MF. Comparing a combination of validated questionnaires and level III portable monitor with polysomnography to diagnose and exclude sleep apnea. J Clin Sleep Med. 2013;9(12):1259-66.
• Referans18 Yumino D1, Tsurumi Y, Takagi A, Suzuki K, Kasanuki H. Impact of obstructive sleep apnea on clinical and angiographic outcomes following percutaneous coronary intervention in patients with acute coronary syndrome. Am J Cardiol. 2007; 99 (1):26-30.
• Referans19 Lee CH, Khoo SM, Tai BC, et al. Obstructive sleep apnea in patients admitted for acute myocardial infarction. Prevalence, predictors, and effect on microvascular perfusion. Chest. 2009; 135:1488–95.
• Referans20 Ip MS, Lam B, Tang LC, Lauder IJ, Ip TY, Lam WK. A community study of sleep-disordered breathing in middle-aged Chinese women in Hong Kong: prevalence and gender differences. Chest 2004; 125:127–134.
• Referans21 Young T, Shahar E, Nieto FJ, et al. Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med 2002; 162:893–900.