Effect Of Obstructive Sleep Apnea During Rapid Eye Movement On Prognosis Of Patients With Acute Myocardial Infarction

Objective: This study analye the clinical data of patients with obstructive sleep apnea during rapid eye movement（REM-OSA）who were clinically diagnosed as acute myocardial infarction,understand the disease characteristics,and further explore the impact of REM-OSA on the prognosis of patients with acute myocardial infarction,providing new ideas for the clinical diagnosis and treatment of patients with acute myocardial infarction.Methods: In this study,patients with acute myocardial infarction who were hospitalized in the Department of Cardiology,Affiliated Provincial Hospital of Anhui Medical University from May 2019 to January 2020 were selected.Patients were divided into two groups: REM-OSA group and non-REM-OSA group according to the sleep apnea index（AHI）,the sleep apnea index in the rapid eye movement period（REM-AHI）,the sleep apnea index in the non-rapid eye movement period（NREM-AHI）and the sleep time in the rapid eye movement period（REM time）monitored by the Watch PAT 200 device.The diagnostic criteria for REM-OSA are REM time≥30 min,AHI≥5 times/hour,REM-AHI > 15 times/hour,NREM-AHI≤15 times/hour and REM-AHI/NREM-AHI > 2.Collect basic data on patients,including general clinical data,such as age,height,weight,sex,medical history（hypertension,diabetes,previous myocardial infarction,previous PCI）,personal history（smoking）,Myocardial infarction classification（STEMI/NSTEMI）,This hospitalization was treated with PCI therapy,laboratory examination data（Blood routine,blood glucose related indicators,blood lipid related indicators,left ventricular function indicators,etc）and sleep monitoring data,and patients were followed up 24 months after discharge by telephone.Major adverse cardiac events（MACE）such as cardiogenic death,nonfatal myocardial infarction,rehospitalization for angina or arrhythmia,or heart failure were recorded and further statistical analysis was performed.Results: A total of 137 patients with acute myocardial infarction were enrolled,85 in REM-OSA group and 52 in non-REM-OSA group.Statistically,there were no significant differences in gender,age,past medical history,personal history,Myocardial infarction classification（STEMI/NSTEMI）,This hospitalization was treated with interventional therapyand laboratory examination results between the two groups.Body mass index（BMI）of patients in REM-OSA group（25.22 ± 3.307Kg/㎡ VS 22.89 ±5.488Kg/㎡）was significantly higher than that in control group,and the difference was statistically significant（P<0.05）.K-M survival analysis showed that with the extension of follow-up time,proportion without event of patients in REM-OSA group was significantly lower than that in non-REM-OSA group（P = 0.002,P < 0.05）,and With the degree of REM-OSA increased,proportion without event was lower（P = 0.001,P <0.05）.Univariate Cox regression analysis showed that BMI（HR = 1.099,95%CI:1.008-1.199,P = 0.032,P < 0.05）,REM-AHI（HR = 1.038,95%CI: 1.012-1.066,P =0.005,P < 0.05）and REM-OSA（HR = 3.902,95%CI: 1.626-9.361,P = 0.002,P < 0.05）were risk factors for MACE events within 24 months in patients with acute myocardial infarction.Multivariate Cox regression analysis showed that the REM-OSA was an independent risk factor for MACE events in patients within 24 months with acute myocardial infarction（HR = 3.084,95%CI: 1.007-9.439,P = 0.048,P < 0.05）.Conclusion: Patients with acute myocardial infarction and REM-OSA have a higher BMI and a higher incidence of MACE events within 24 months.REM-OSA is an independent risk factor for MACE events within 24 months in patients with acute myocardial infarction.