Estimate The Effects Of NCPAP Treatment To The Myocardial Blood-Supply And Cardiac Electrical Activity In Patients With Moderate-severe Obstructive Sleep Apnea-Hypopnea Syndrome

Objective To investigate the moderate-severe OSAHS in relation to myocardial blood-supply and cardiac electrical activity,and explore the effects of nasal continuous positive airwaypressure on these patients.Methods We recruited moderate-severe OSAHS from January2009to May2011, andrandomly selected32as long-term nCPAP therapy group(A group), which accepted more than1year nCPAP therapy,30patients with untreated group(B group),31who accepted to1day nCPAPtherapy as short-term treatment group(C group).Everyone use an overnight sleep study and Holterrecording to examine disordered breathing,cardiac arrhythmias,ST segment depression,heart ratevariability.Real time observation of sleep disordered breathing events duration and frequency ofoccurrence with ST segment depression and arrhythmias.Results In the control group,there were13patients(41.94%)occurred myocardial ischemic inthe night,the ischemic burden during sleep was(59.12±7.18)mm·min/h.The relation betweenmyocardial ischemic and sleep apnea-hypopnea,with total duration time and total frequency,waspositive in moderate-severe OSAHS(r=0.816，P＜0.001；r=0.749，P＜0.05).The occurrence ofmyocardial ischemic also followed with the oxygen desaturation(P＜0.01).All of the patients incontrol group had arrhythmias. We compared with the occurrence of two kinds of arrhythmiasslow arrhythmias and fast arrhythmias,in different duration time of the sleep apnea-hypopnea.Nomatter how long of the duration,low arrhythmias were more than fast arrhythmias(P＜0.001).Thelonger the sleep apnea-hypopnea lasted,the more arrhythmias occurred.In long-term nCPAP therapy group,there were only2patients(6.25%)occurred myocardialischemic in the night,the ischemic burden during sleep was(1.32±0.78)mm·min/h.Compared withthe control group,which had significantly decreased(P＜0.01).And long-term therapy could reducethe frequency of arrhythmias in the night:sinus bradycardia(45.69±20.12VS.175.03±26.4,P＜0.05),sinus pause(1.50±0.12VS.7.29±2.25,P＜0.05), II degree atrioventricular block(0.03±0.01VS.4.03±0.25，P＜0.05),atrial tachycardia short run(0.09±0.01VS.6.13±1.47，P＜0.05),ventricularpremature beat(17.12±3.47VS.65.74±4.38，P＜0.05),ventricular tachycardia(0.00±0.00VS.33.68±1.38，P＜0.01).In short-term nCPAP therapy group,there were only3patients(10.00%)occurred myocardialischemic in the night.the ischemic burden during sleep was(2.42±1.43)mm·min/h.Compared withthe control group,which had significantly reduced(P＜0.01).The short-time therapy also couldreduce the frequency of arrhythmias:sinus bradycardia(90.20±28.17VS.175.03±26.43，P＜0.05),sinus pause(1.73±2.12VS.7.29±2.25，P＜0.05), II degree atrioventricular block(0.60±0.29 VS.4.03±0.25，P＜0.05),atrial tachycardia short run(0.33±0.21VS.6.13±1.47，P＜0.05),ventricular tachycardia(0.00±0.00VS.33.68±1.38，P＜0.01).The therapeutical effect is distinguished and is the same with the moderate-severe OSAHS inboth daytime nap and nocturnal sleep.The ischemic burden during daytime was(3.10±1.28)mm·min/h and (2.42±1.43)mm·min/h during nighttime.The occurrence of low arrhythmias indaytime was(30.00%)and(26.67%)in nighttime.The occurrence of low arrhythmias in daytimewas(23.33%)and(16.67%)in nighttime.There was no significant difference between them(P＞0.05，P＞0.05).Compared with the heart rate viability of the three groups,in the frequency distribution ofvariables,compared with the control group,the long-term therapy group was removed in the way ofVLF and HF(P＜0.01,P＜0.05),the short-term therapy group also reduced significantly in the wayof VLF(P＜0.01).In the time distribution of variables,compared with the control group,the long-term therapy group was removed in the way of rMSSD、pNN50(P＜0.05，P＜0.05).Therewas no significant statistical difference between the short-time therapy group and thecontrol group.Conclusion Nocturnal myocardial ischemia and arrhythmias were common in patients withmoderate-severe OSAHS,which may relate with apnea-hypopnea and oxygen desaturation. Nomatter long-term therapy or short-term therapy,nCPAP can significantly reduce the occurrence ofischemic and ischemic burden,also can decrease the incidence of the arrhythmias.Daytime nappingand nocturnal sleep therapy effect of nCPAP had no significant difference,which prompt daytimetreatment to become feasible.