Relationship Between Obstructive Sleep Apnea And Coronary Microcirculatory Function Among Patients With Coronary Atherosclerotic Heart Disease

Background Changes in epicardial coronary vascular structure and function are the most frequent and important causes for myocardial ischemia, angina symptoms. However, in recent years, a growing number of studies showed that the abnormal coronary microcirculation can also lead to reduced coronary blood flow and myocardial ischemia. Many studies had also confirmed that the coronary microcirculatory dysfunction plays an important role in the occurrence and development of coronary heart disease (CHD), which directly or indirectly affect the health of the patient. The index of microcirculatory resistance (IMR), a new method of assessing coronary microcirculation, its measurement is not affected by the extent of coronary stenosis, and provides the possible to study the association between various risk factors and the microcirculatory dysfunction. And recent studies had shown that tumor necrosis factor -α (TNF-α) increased release in the presence of a coronary microcirculatory dysfunction in patients, and also is an effective method of assessing the extent microcirculatory dysfunction.Obstructive sleep apnea syndrome (OSAS) is a common disease, which can cause a range of physiological disorders such as hypoxia and activation of the sympathetic nervous system, while may result in adverse cardiovascular events. Recent studies indicate that there is a connection between OSAS and microvascular disease, many years of clinical observation also found that in large part of patients with CHD in cardiovascular medicine had OSAS. The occurrence and development of OSAS closely linked with coronary microcirculatory dysfunction.In this study, the research of coronary microcirculatory dysfunction in patients with CHD and OSAS determines the effect and possible mechanisms of OSAS on coronary microcirculatory dysfunction.Objectives By way of grouping, conduct an intervention check and measure IMR value and the result of serum TNF-a in OSAS, CHD and OSAS with CHD patients, compared with the control group, as well as a comparison between the experimental groups, determined the effect and possible mechanisms of OSAS on coronary microcirculatory dysfunction.Methods Screened 97 patients who took coronary angiography and apply pressure guide wire measuring IMR results in our hospital and with the complete medical records from January 2013-September 2014, which were screened and divided into 3 groups (Test Group 1:22 patients with OSAS; Test Group 2:35 patients with CHD; Test Group 3:27 patients with OSAS and CHD. The control group:13 volunteers without CHD and OSAS). TNF-a in serum was tested by ELISA method and IMR examination was implemented to patients.Results TNF-a and IMR values of OSAS patients and CHD patients was significantly higher compared with the control groups, and there was statistically significant; and TNF-a and IMR values in patients with OSAS compared with CHD patients, the difference was not statistically significant; It worth note that, TNF-a and IMR values of CHD with OSAS patients were higher than CHD patients, this difference is statistically significant. All study groups compared with the control groups, had higher cholesterol, LDL levels, and may be more prone to being overweight. Taken together, there is a linear relationship between TNF-a and IMR values of all subjects.Conclusions 1. The patients with CHD or OSAS had high cholesterol, LDL levels, and may be more prone to being overweight, and patients with CHD and OSAS higher cholesterol, LDL levels2. There is a linear relationship between TNF-a and IMR values of all subjects.3. This study support the closely relationship of OSAS and vascular inflammation reaction, and further confirmed that OSAS may cause coronary microcirculatory dysfunction or aggravated coronary microcirculatory dysfunction of CHD patients by vascular inflammation reaction.