An Analysis On Correlation Between Obstructive Sleep Apneasyndrome And Restenosis After PCI

BackgroundOver half a century, with the improvement of social economy, the changes of human’s lifestyle and diet, the spectrum of disease and death in China have greatly changed. In the late 20 th century, all kinds of chronic disease is being the main threat to the human’s health, especially the proportion of cardiovascular disease. The outline of Chinese cardiovascular disease report 2013 shows that the death of cardiovascular accounted for the first cause of death overall urban and rural areas, 38.7% in rural areas, and 41.1% in the city, and the prevalence continues to rise in stages. The cardiovascular disease will become a major killer to human’s health. Acute coronary syndrome(ACS), as a common but serious cardiovascular disease, is a group of clinical syndrome which based on plaque rupture or bleeding, secondary incomplete or complete occlusion of coronary artery. At present, the percutaneous coronary intervention(PCI) has become the primary treatment of ACS, in addition to non-pharmacological intervention, drug prevention and control of cardiovascular external risk factors. PCI is the most effective way to treat coronary artery disease. The drug-eluting stent(DES) makes the incidence of the in-stent restenosis(ISR) low, which makes PCI widely be accepted and promoted in the crowd. However, the problems of endothelial tissue injury, thrombosis and heterologous exclusion of stent all exit in patients with risk factors of ACS, plus the presence of anti-platelet drug resistance, ISR remains the focus problem. ACS patients can achieve a high incidence of ISR about 10%. In order to improve the clinical effect of PCI, many experts and scholars have analyzed and discussed the factors of ISR. Previous retrospective studies have shown that the main factors affecting the ISR include smoking, plasma fibrinogen(FIB) levels, hypertension, diabetes and multivessel coronary artery disease, but as a kind of recurrent airway obstruction sleep disorders, epidemiological surveys: prevalence of obstructive sleep apnea syndrome(OSAS) of adults is 2%-4%, over 65 year’old is 45%, and the trend of the incidence rate will be increasing. Recent studies have found that OSAS is closely related to hypertension, cardiac arrhythmias, coronary heart disease and pulmonary hypertension, maybe involve in the occurrence and development of cardiovascular disease. In addition, Dai Yumino’s findings indicate that OSAS may make the patients after PCI encounter myocardial infarction again, and increase the incidence of death in hospital, but whether it is related to ISR and how much OSAS will impact with ISR is not known. In this study, we will analyse the correlation between OSAS and ISR, whether OSAS is a dependent risk factor to ISR, and explore the machanism about it in order to provide the clinical evidence for the secondary prevention of ISR. Subjects and Methods:Selecting 158 patients which proceeded PCI successfully in the First Affiliated Hospital of Zhengzhou University, and reviewed coronary angiography(CAG) after 12 months of PCI during 2013.1 to 2014.12. According to the results of CAG, all the patients were divided into two groups as in-stent restenosis group(ISR group) and non-stent restenosis group(non-ISR group). 39 patients were in ISR group, 28 males, mean age:(57.92 ± 9.40) years old; 119 patients were in non-ISR group, 102 cases of male, mean age:(57.67 ± 9.53) years old. Basic clinical data, biochemical indicators and information about coronary interventional procedure were retrospectively collected for all patients on admission. Analysed whether OSAS is an independent risk factor of ISR Using the method of binary logistic regression. Results:1.univariate analysis showed : ①the rate of OSAS patients in ISR group was higher than that in non-ISR group(62% vs 37%), P=0.007, which was considered significant difference; ②the rate of diabetes in ISR group was higher than that in non-ISR group(28% vs 12%), P=0.015, which was considered statistically meaningful; ③the diameter of stent in ISR group was smaller than that in non-ISR group(2.93±0.40 mm vs 3.22±0.55 mm), P=0.001, which was considered statistically meaningful.2. Binary logistic regression analysis: OSAS(OR=2.937, 95% CI: 1.336 ~ 6.456), diabetes(OR=2.818, 95% CI: 1.088 ~ 7.301) was the risk factor of ISR, larger diameter of the stent(OR = 0.312, 95% CI: 0.132 ~ 0.735) was the protective factor of ISR. Conclusions:1. OSAS, diabetes and diameter of the stent were associated with ISR;2. OSAS, diabetes was maybe the risk factor of ISR, larger diameter of the stent was maybe the protective factor of ISR.