Relationship between obstructive sleep apnea hypopnea syndrome and new-onset atrial fibrillation after coronary artery bypass grafting
Objective To observe the occurrence of obstructive sleep apnea hypopnea syndrome(OSAHS)in patients with coronary heart disease before coronary artery bypass grafting(CABG),and to explore the relationship between OSAHS and new-onset atrial fibrillation after CABG.Methods Totally 156 patients with coronary heart disease underwent polysomnography and OSAHS grading before CABG in the First Affiliated Hospital of Zhengzhou University from January to December 2022,and were divided into moderate to severe OSAHS group(n=49),mild OSAHS group(n=57),and normal OSAHS group(n=50).The gender ratio,age,diabetes,hypertension,body mass index,apnea-hypopnea index(AHI),low-density lipoprotein cholesterol,blood creatinine and high sensitivity C-reactive protein,left atrial diameter(LAD),left ventricular ejection fraction(LVEF),and left ventricular end-diastolic volume(LVEDV)before CABG were compared among three groups.The number of bypass grafts,intra-aortic balloon pump(IABP)/extracorporeal membrane oxygenation(ECMO)therapy,pleural effusion,pulmonary infection,mechanical ventilation time,length of ICU stay,and length of hospital stay were recorded.Echocardiography was done again 3 months after CABG to record the LAD,LVEF and LVEDV.The follow-up was done till March 2023 to record the incidence of new-onset atrial fibrillation and readmission due to major adverse cardiovascular events such as restenosis,thrombosis,bridging dysfunction,arrhythmia and angina.Univariate and multivariate logistic regression analyses were conducted to evaluate the influencing factors of new-onset atrial fibrillation after CABG in patients with coronary heart disease complicated with OSAHS.ROC curves were plotted to assess the efficiencies of preoperative high sensitivity C-reactive protein and AHI on predicting new-onset atrial fibrillation after CABG.Results(1)There were significant differences in the body mass index and AHI among three groups(F=18.388,P＜0.001;F=15.469,P＜0.001).The body mass index and AHI increased sequentially in normal group[(22.3±1.1)kg/m2,(2.3±2.1)times/h],mild OSAHS group[(25.3±2.1)kg/m2,(8.4±3.6)times/h]and moderate to severe OSAHS group[(26.9±1.8)kg/m2,(28.0±7.9)times/h](P＜0.05).There were no significant differences in the gender ratio,age,and proportions of hypertension and diabetes among three groups(P＞0.05).(2)There were no significant differences in the low-density lipoprotein cholesterol level,blood creatinine level,LAD,LVEF and LVEDV before CABG,number of bridges,rates of IABP/ECMO therapy,pleural effusion and pulmonary infection,and LAD 3 months after CABG among three groups(P＞0.05).The preoperative high sensitivity C-reactive protein level was higher in moderate to severe OSAHS group[(3.6±1.1)mg/L]than that in mild OSAHS group[(2.8±0.6)mL]and normal group[(2.1±0.7)mL](P＜0.05).The LVEDV was larger in moderate to severe OSAHS group[(124.1±18.2)mL]than that in mild OSAHS group[(110.8±10.1)mL]and normal group[(109.9±12.2)mL],and the LVEF was lower in moderate to severe OSAHS group[(55.4±3.2)％]than that in mild OSAHS group[(59.4±2.1)％]and normal group[(59.1±3.5)％]3 months after CABG(P＜0.05).The mechanical ventilation time,length of ICU stay and length of hospital stay were longer in moderate to severe OSAHS group[(20.0±8.9)h,(54.3±9.8)h,(13.2±3.0)d]than those in mild OSAHS group[(10.5±4.6)h,(42.9±8.7)h,(10.2±2.7)d]and normal group[(11.1±2.5)h,(40.4±6.7)h,(10.0±1.3)d](P＜0.05).All the above indexes showed no significant differences between mild OSAHS group and normal group(P＞0.05).(3)The follow-up till March 2023 showed that the incidence rate of new-onset atrial fibrillation was higher in moderate to severe OSAHS group(24.4％)than that in mild OSAHS group(8.8％)and normal group(4.0％)(x2=4.834,P=0.029;x2=5.614,P=0.003),and there was no significant difference between mild OSAHS group and normal group(P＞0.05).During the follow-up,6 patients in moderate to severe OSAHS group and 1 patient in mild OSAHS group were readmitted due to angina pectoris.Coronary angiography detected no bridging vessel stenosis,which was relieved after mechanical pressure titration combined with non-invasive ventilation.No major adverse cardiovascular events occurred in normal group.(4)Preoperative high sensitivity C-reactive protein(OR=1.766,95％CI:1.226-4.990,P=0.016)and AHI(OR=1.101,95％CI:1.031-1.175,P=0.004)were the influencing factors of new-onset atrial fibrillation after CABG in patients with coronary heart disease and OSAHS.(5)When the optimal cut-off values of high sensitivity C-reactive protein and AHI were 3.75 mg/L and 36.5 times/h,the AUCs for predicting new-onset atrial fibrillation after CABG were 0.728(95％CI:0.584-0.872,P=0.003)and 0.805(95％CI:0.668-0.943,P＜0.001),with the sensitivities of 68.9％and 72.4％,and the specificities of 50.2％and 52.7％,respectively.The AUC of the combined detection of them two was 0.837(95％CI:0.721-0.954,P＜0.001),with a sensitivity of 94.1％and a specificity of 59.6％.Conclusions Patients with coronary heart disease are prone to OSAHS,and moderate to severe OSAHS would affect the postoperative cardiac function recovery,and often cause new-onset atrial fibrillation and major adverse cardiovascular events.The combination of preoperative high sensitivity C-reactive protein and AHI has a high sensitivity.
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万方数据
维普
