[AF-FORUM] 17E 睡眠呼吸暂停综合征 Dr. Larrateguy

[AF Symposium]

谢谢你的精彩回答，Pérez Riera医生
我经常遇到患有睡眠呼吸暂停综合征的患者，但是我 
们国家的很多心血管专家都不重视此综合征，尽管著 
名的文献中提到它是心血管疾病的病因。不管怎样， 
我的问题是有关中国医生杨东辉提出的病例，我想问 
他是否治疗患者的睡眠呼吸暂停综合征。如你所说， 
用持续肺泡正压的方法治疗呼吸睡眠暂停可以降低房 
颤的再发率。(Kanagala R. Circulation, Mayo 2003 107: 2589-2594.)
     此致
敬礼

Luis Darío Larrateguy

www.RespirarParana.com.ar

Dr. Sergio Dubner
科委会主席
Dr. Edgardo Schapachnik
组委会主席

亲爱的来自阿根廷的Luis Larrateguy医生，我是来自巴西 
的Andrés Ricardo Pérez Riera：阻塞性呼吸睡眠暂停综合 
征可能容易诱发慢性房颤。随着年龄的增加房颤的患 
病率也随之增加。相当多的证据更支持阻塞性呼吸睡 
眠暂停与心血管疾病无关，这些证据更支持OSAS与以 
下疾病有关：
1）高血压：40％到60％的患病率
2）冠心病伴有或不伴有心肌梗死：20％到30的患病率
3）脑卒中：严重的OSAS（定义为呼吸暂停至呼吸减 
弱，指数为30）增加了老年病人患缺血性脑卒中的危 
险，不依赖已知的致混淆因素（1）。
4）充血性心力衰竭伴高水平利钠肽：5％到10％的患 
病率
6）房颤
7）心源性猝死
8）代谢综合征

长期的持续正压气道通气可使重要的临床终点事件如 
心急梗死和脑卒中的发生率降低。

人口统计资料表明房颤发病率的增加并不能完全用年 
龄增加来解释。美国患房颤的人口数量将从现在的230 
万上升到2050年的1000万。异常的危险因素－肥胖和OSAS 
可能成为AF的部分病因。

OSAS病人的患心血管病的发病机制是多因素的，包括
1）交感神经系统过度活跃
2）炎性分子路径的选择性激活
3）内皮功能障碍
4）凝血异常
5）代谢综合征伴胰岛素抵抗，向心型肥胖，2型糖尿 
病和血脂代谢障碍：低HDL-C和高甘油三脂血症。
OSAS的重要病理生理结果肥胖和夜间氧气去饱和强 
度，对于年龄小于65岁的人来讲并不是偶发房颤事件 
的危险因素。
肺静脉传导的快速恢复经常会出现在成功的肺静脉电 
隔离之后，尤其是非阵发性房颤、高血压、左房增 
大、OSAS的老年患者。

参考文献
1)        Munoz R, Duran-Cantolla J Marinez-Vila E, et al. Severe  
sleep apnea and risk of ischemic stroke in the elderly Stroke. 2006;  
37:2317-21.
  2)        Schulz R, Greve M, Eisele HJ, et al. Obstructive sleep  
apnea-related cardiovascular disease Med Klin (Munich). 2006;    
101:321-7
  3)        Gami AS, Hodge GO, Herques RM, et al. Obstructive sleep  
apnea, obesity, and the risk of incident atrial fibrillation J Am  
Coll  Cardiol. 2007;49:565-71.
  4)        Sauer WH, McKernan ML, Lin D, et al. Clinical predictors  
and outcomes associated with acute return of pulmonary vein  
conduction during pulmonary vein isolation for treatment of atrial  
fibrillation. Heart Rhythm. 2006; 3:1024-8.

  All the best for all

 > Andrés Ricardo Pérez Riera MD Chief of Electro-Vectocardiology  
Sector of the Discipline of Cardiology,ABC Faculty of Medicine  
(FMABC), Foundation of ABC (FUABC) - Santo André - São Paulo -
 > Brazil.riera在uol.com.br
问题：睡眠呼吸暂停综合征不能成为房颤复发的原因 
吗？
Dr. Luis Larrateguy (阿根廷)
Neumonólogo
 >> www.RespirarParana.com.ar
邸亚丽译


17 E  Sleep apnea. Dr. Larrateguy
Thaks you for your excelent answer, Dr. Pérez Riera.
I´m used to treat patients with sleep apnea, but most of  
cardiologist  that live in my country don´t pay much atention to this  
Syndrome  suchs as a cause of CVD despite of the well known   
bibliography  about. Anyway my question was about the case introduced  
by Dr Donghui  Yang from China, asking if he had eliminated the sleep  
apnea sindrome.As you said, sleep apnea sindrome treatment with CPAP  
is asociated  with a reduction in the rate of recurrence of atrial  
fibrillation.  (Kanagala R. Circulation, Mayo 2003 107: 2589-2594.)
Best regard
Luis Darío Larrateguy
www.RespirarParana.com.ar

Dr. Sergio Dubner
President of Scientific Committee
Dr. Edgardo Schapachnik
President of Steering Committee

 > Dear Dr. Luis Larrateguy  from Argentina. Here Andrés Ricardo  
Pérez Riera from São Paulo Brazil: Chronic AF may have predisposed  
to obstructive sleep apnea syndrome (OSAS). The prevalence of AF  
increases with age. Considerable evidence is available in support of  
an independent association between OSAS and cardiovascular disease,  
which is particularly strong for:
 > 1)       Hypertension: prevalence 40% to 60%;
 > 2)       Coronary artery disease with or without myocardial
 > infarction: prevalence 20 to 30%;
 > 3)       Stroke: Severe OSAS (defined as apnea-hypopnea index ?30)
 > increases the risk of ischemic stroke in the elderly population,
 > independent of known confounding factors (1).
 > 4)       Congestive heart failure with higher natriuretic peptide  
levels: prevalence 5 to 10%;
 > 5)       Pulmonary hipertensión: prevalece 20 to 30% (2);
 > 6)       AF;
 > 7)       SCD;
 > 8)       Metabolic syndrome.
 > Long-term continuous positive airway pressure therapy leads to a  
reduction in important clinical endpoints such as the rates of  
myocardial infarction and stroke.
  Population-based data indicate a trend of increasing incidence and  
prevalence of AF that is incompletely explained by an aging  
population. The number of Americans afflicted by AF will increase  
from the current 2.3 million to more than 10 million by 2050. Novel  
risk factors-obesity and OSAS may partially account for the current  
AF epidemic. The pathogenesis of cardiovascular disease in OSAS is  
multifactorial,
 > involving
 > 1)       Sympathetic nervous system overactivity;
 > 2)       Selective activation of inflammatory molecular pathways;
 > 3)       Endothelial dysfunction;
 > 4)       Abnormal coagulation;
  e5)       Metabolic syndrome with insulin resistance, centripetal  
obesity, type 2 diabetes and dyslipidemia: low HDL-C and  
hypertriglyceridemia. Obesity and the magnitude of nocturnal oxygen  
desaturation, which is an important pathophysiological consequence of  
OSAS, are independent risk factors for incident AF in individuals  
lesser than 65 yo (3).
  Acute return of pulmonary vein conduction is common after  
successful pulmonary vein electrical isolation  and is more likely to  
occur in older patients with nonparoxysmal AF, hypertension, a large  
left atrium, and OSAS(4)
 > References
 > 1)        Munoz R, Duran-Cantolla J Marinez-Vila E, et al. Severe  
sleep apnea and risk of ischemic stroke in the elderly Stroke. 2006;  
37:2317-21.
 > 2)        Schulz R, Greve M, Eisele HJ, et al. Obstructive sleep  
apnea-related cardiovascular disease Med Klin (Munich). 2006;  101:321-7
 > 3)        Gami AS, Hodge GO, Herques RM, et al. Obstructive sleep>  
apnea, obesity, and the risk of incident atrial fibrillation J Am  
Coll  Cardiol. 2007;49:565-71.
 > 4)        Sauer WH, McKernan ML, Lin D, et al. Clinical predictors  
and outcomes associated with acute return of pulmonary vein  
conduction during pulmonary vein isolation for treatment of atrial  
fibrillation. Heart Rhythm. 2006; 3:1024-8.
 > All the best for all

 > Andrés Ricardo Pérez Riera MD Chief of Electro-Vectocardiology  
Sector of the Discipline of Cardiology,ABC Faculty of Medicine  
(FMABC), Foundation of ABC (FUABC) - Santo André - São Paulo -

 > Brazil.riera在uol.com.br
 >> Question: Did sleep apnea syndromes were ruled out in this  
patient as a cause for recurring AF?
 >> Dr. Luis Larrateguy (Argentina)
 >> Neumonólogo
 >> www.RespirarParana.com.ar
_______________________________________________
Af-forum mailing list
Af-forum在af-symposium.org


--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee