The coexistence of obstructive sleep apnea in patients with slow coronary flow: a cross-sectional study

Year 2020, Volume: 2 Issue: 4, 112 - 116, 23.09.2020

Arslan Ocal , Ersin Saricam , Nihal Basay Gulcın Sarıyıldız

https://doi.org/10.38053/acmj.753838

Abstract

BACKGROUND: Interestingly, obstructive sleep apnea (OSA) and coronary slow-flow (CSF) have similar pathogenic mechanisms, including increased sympathetic activity and endothelial dysfunction. However, the association between OSA and CSF is not known well. If undiagnosed, OSA is a cause of increased cardiovascular morbidity and mortality. We investigated the presence of OSA in the patients diagnosed CSF after coronary angiography.
METHODS: The prospective cross-sectional study included 4515 patients admitted angiography laboratory from February 2018 to March December 2019. After coronary angiography of 4515 patients, 336 patients were diagnosed as slow coronary flow. These patients were examined by pulmonology and sleep specialist. Of the 336 patients, 276 patients were found high risk in terms of OSA by using Berlin questionnaire (BQ). Only 75 of 276 patients underwent polysomnography (PSG) testing. Control group patients (n=40) had normal coronary artery and no OSA.
RESULTS: Of 4515 patients, 336 (7.4%) met the criteria for CSF. After BQ, 276 of 336 patients had high-score BQ (82.1%). The study group consisted of 276 patients (188 males, 88 females). The mean ages of the study group were 48.48 ±7.61 years. Body mass index (BMI) according to WHO criteria was 33.02±2.18 kg/m2. When 75 patients underwent PSG were divided on two groups as mild OSA and moderate/severe OSA according to respiratory disturbance index (RDI). We found a significant positive correlation between mean corrected TIMI Frame Count (CTFC) and RDI. While CTFC-Lad in mild OSA group was 32.73, CTFC-Lad in moderate/severe OSA group was 35.04 (p=0.022). While CTFC-Cx in mild OSA group was 31.67, CTFC-Cx in moderate/severe OSA group was 35.26 (p=0.001). While CTFC-Rca in mild OSA group was 32.57, CTFC-Rca in moderate/severe OSA group was 36.33 (p<0.001).
CONCLUSION: This study revealed the coexistence between CSF and OSA. Moreover, we demonstrated a significant relationship between mean CTFC and RDI. To determine the clinical association of OSA and CSF may be help to understand pathophysiology of CSF.

Keywords

Coronary slow flow, Obstructive sleep apnea

Koroner yavaş akım hastalarında obstrüktif uyku apnesi birlikteliği: Kesitsel çalışma

Abstract

Amaç: Obstrüktif uyku apnesi (OUA) ve koroner yavaş akım (KYA) ilginç olarak artmış sempatik aktivite ve endotelyal disfonksiyon gibi benzer patolojik mekanizmalara sahiptir. Fakat OUA ve KYA arasındaki birliktelik çok iyi bilinmemektedir. Eğer tanı konmazsa, OUA artmış kardiyovasküler mortalite ve morbidite nedenlerinden biridir. Biz bu çalışmada koroner anjiyografi sonrası KYA tanısı almış hastalarda OUA varlığını araştırdık.
Gereç ve Yöntem: Bu prospektif kesitsel çalışma Şubat 2018-Aralık 2019 yılları arası anjiyografiye alınan 4515 hastayı kapsamaktadır. Koroner anjiyografi sonrası 4515 hastanın 336 sına YKA tanısı konmuştur. Bu 336 hastanın 276 sı Berlin anket bulgularına göre yüksek riskli olarak bulunmuştur. Çalışma grubu 276 hastadan oluşmaktaydı. Bu hastalardan 75 ine polisomnografi testi yapılmıştır. Kontrol grubu (40 hasta) normal koroner arterli ve OUA olmayan hastalardı.
Bulgular: 4515 hastanın 336 sı KYA tanısı almıştı (%7.4). Berlin anket çalışması sonrası 336 hastanın 276 sı yüksek risk grubu idi (%82.1). Çalışma grubu 188 erkek, 88 kadından oluşmaktaydı (toplam 276 hasta). Ortalama yaş 48.48 ±7.61 yıl idi. Vücut kitle indeksi 33.02±2.18 kg/m2 idi. Polisomnografi yapılan 75 hasta solunum bozukluk indeksine göre hafif ve orta/ağır derece olarak iki gruba ayrılmıştır. Biz solunum bozukluk indeksi ve düzeltilmiş TIMI sayımı arasında pozitif ilişki saptadık. Hafif grupta CTFC-Lad değeri 32.73, orta/ağır grupta CTFC-Lad değeri 35.04 (p=0.022). Hafif grupta CTFC-Cx değeri 31.67, orta/ağır grupta CTFC-Cx değeri 35.26 (p=0.001). Hafif grupta CTFC-Rca değeri 32.57, orta/ağır CTFC-Rca değeri 36.33 (p<0.001).
Sonuç: Bu çalışma OUA ve KYA arasında birliktelik olduğunu ortaya koymuştur. İlave olarak biz solunum bozukluk indeksi ile ortalama düzeltilmiş TIMI sayımı arasında anlamlı ilişkiyi gösterdik. OUA ve KYA birlikteliğinin saptanması KYA ın patofizyolojisini anlamada yardımcı olur.

Keywords

koroner yavaş akım, obstrüktif uyku apnesi

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