The Clinical Study About The Relation Between Sleep Apnea Hypopnea Syndrome And Nocturnal Angina

Objective: Sleep apnea hypopnea syndrome (SAHS) is a disease of potential danger, it is the independent risk factor for the happen of hypertension, coronary artery disease, myocardial infarction and cerebral accidents, it is the clinically common reason of sudden death. The objective of this experiment is to study the correlation between SAHS and nocturnal angina in order to search a new idea for the treatment of nocturnal angina.Methods: 64 patients of coronary artery disease were selected randomly from hospitalization or out-patient clinic from 2005.7 to 2006.12. All the patients were diagnosed with coronary arteriongraphy or ECG and other diagnostic methods, 36 male patients and 28 female patients, the age was from 42 to 79 years old and the mean age was 56.65±8.90 years old, the mean body mass index (BMI) was 29.15±4.92 kg/m2. All the patients were divided into two groups according to whether they had nocturnal angina, 35 patients were the nocturnal angina group (NA group) and 29 patients were the simple coronary artery disease group (s-CAD group). There was no difference between the two groups in sex, age, BMI and drug treatment, the patients of the two groups were examined with ECG, heart ultrasonic and blood biochemistry. First the patients of the two groups underwent polysomnography (PSG) for 7 hours in sleeping laboratory, and then compare the incidence of SAHS and the parameters of the PSG in order to research the correlation between SAHS and nocturnal angina from the view of PSG; in the mean time all the patients underwent dynamic electrocardiogram (DCG) to research the occurrence of depression of ST and cardiac arrhythmia. And for the SAHS group which had 20 patients and non-SAHS group which had 15 patients of the NA group, we analyzed the results of DCG and compared the difference in nocturnal angina, myocardial ischemia, heart rate and ST parameters between the two groups in order to research the correlation between SAHS and nocturnal angina from the view of DCG. The patients of the NA group were divided into mild, moderate, severe and non-SAHS groups according to the value of the apnea hypopnea index (AHI), and then the maximal depression degree of ST were compared among the four groups. In the mean time the correlation between the maximal depression degree of ST of the patients and AHI, oxygende-saturation index (ODI) and the lowest SaO2 (LSaO2) were analyzed respectively.Results: (1)The general information: there were no differences in the general information, drug treatment and the results of coronary arteriongraphy between the NA group and the s-CAD group. (2)The results of PSG: there was no significant difference in the incidence of SAHS between the NA group and the s-CAD group (P>0.05); the AHI and ODI of the NA group were apparently higher than the s-CAD group (P<0.05); but there was no significant difference in the microarousal index (MI) between the two groups (P>0.05); and the LSaO2 of the NA group was apparently lower than the s-CAD group (P<0.05); but there was no significant difference in the mean SaO2 (MSaO2) between the two groups (P>0.05); and the longest apnoea time of the NA group was apparently longer than the s-CAD group (P<0.05). And then the sleep architecture were compared. The time of the stage I sleep stage of the NA group was apparently longer than the s-CAD group (P<0.05); but there was no significant difference of the time of stage II sleep stage between the two groups (P>0.05); and the time of deep sleep(III+IVstage) of the NA group was apparently shorter than the s-CAD group (P<0.05); and the same as to the REM sleep stage (P<0.05); (3)The results of DCG: the incidence of ST depression and cardiac arrhythmia of the NA group were apparently higher than the s-CAD group (P<0.05). The patients of the NA group were divided into SAHS group with 20 patients and non-SAHS group with 15 patients according to the value of AHI. The frequency of nocturnal angina of the SAHS group was higher than the non-SAHS group, but there was no significant difference (P>0.05); and there was significant difference in the frequency of nocturnal silent ischemia between the two groups (P<0.05); the compared results of the highest and lowest heart rate between the two groups indicated that there was significant difference (P<0.01 or P<0.05). And then the ST parameters of the two groups were compared . The incidence of ST depression of the SAHS group was higher than the non-SAHS group, but there was no significant difference (P>0.05); and both the frequency of ST depression and maximal depression degree of ST of the SAHS group were higher than the non-SAHS group (P<0.05); (4)The analyzed of correlation: the maximal depression degree of ST of the moderate and severe SAHS groups was higher than the mild and non-SAHS groups, and there was significant difference (P < 0.05). There were positive correlations between the maximal depression degree of ST and AHI and ODI respectively, and the correlation coefficient were respectively r= 0.7725 and r= 0.7772, and there were both significant difference (P < 0.01); and there was negative correlation between the maximal depression degree of ST and LSaO2, and the correlation coefficient was r=-0.7496, and there was significant difference (P<0.01).Conclusion: SAHS can influence the incidence of nocturnal angina, silent ischemia and cardiac arrhythmia of the patients with nocturnal angina. There was close correlation between nocturnal angina and SAHS.