BACKGROUND Focusing on detection of sleep apnoea early in the cardiac rehabilitation process may improve the recovery process and reduce recurrence of cardiovascular events. Patients who continue to be undiagnosed may experience a significantly worse outcome during their cardiac rehabilitation and recovery. Diastolic dysfunction has both diagnostic and prognostic importance in the management of coronary artery disease. We hypothesise that undiagnosed/untreated sleep apnoea in middle-aged coronary artery disease patients with preserved left ventricular ejection fraction changes the pattern of diastolic filling close to that in elderly patients without sleep apnoea. METHODS AND RESULTS This cross-sectional study included the 450 coronary artery disease patients with undiagnosed sleep apnoea who had left ventricular ejection fraction ⩾50% and were referred consecutively to the Clinic of Cardiovascular Rehabilitation within two weeks after treatment for acute coronary syndrome. Polysomnographic and echocardiographic measurements were analysed. Mild to severe sleep apnoea was defined as the apnoea-hypopnea index ⩾5. Age was dichotomised into under the age of 60 years and age 60 years or over. Up to 35% of coronary artery disease patients were likely to have undiagnosed sleep apnoea. There was a statistically significant interaction between the effect of sleep apnoea and age group on diastolic function defined as the ratio peak flow velocity in early diastole/peak flow velocity in atrial contraction ratio (p=0.036). This ratio was significantly (p=0.029) lower in the mild-severe sleep apnoea group (0.97, 95% confidence interval 0.88-1.06) than in the non-sleep apnoea group (1.09, 95% confidence interval 1.03-1.15) among middle aged (<60 years) coronary artery disease patients. Therefore, filling patterns in the middle aged (<60 years) patients with sleep apnoea resemble those observed in the elderly (⩾60 years) patients without sleep apnoea. The effect of sleep apnoea on left ventricular filling pattern in elderly was not observed. CONCLUSIONS Age modifies the effect of sleep apnoea on cardiovascular outcomes. The findings that undiagnosed sleep apnoea impairs diastolic function in a middle-aged coronary artery disease patient underscore the importance of early diagnosis and treatment of sleep apnoea. It is recommended to train and educate cardiac rehabilitation staff on the importance of sleep disorders in this population.

中文翻译：

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心脏康复中未确诊的睡眠呼吸暂停：射血分数保留的冠状动脉疾病患者舒张功能的年龄依赖性影响

背景技术在心脏康复过程早期关注睡眠呼吸暂停的检测可以改善恢复过程并减少心血管事件的复发。继续未确诊的患者在心脏康复和恢复期间可能会经历明显更差的结果。舒张功能障碍在冠状动脉疾病的治疗中具有诊断和预后的重要性。我们假设在保留左心室射血分数的中年冠状动脉疾病患者中未诊断/未治疗的睡眠呼吸暂停改变了舒张期充盈模式，接近于没有睡眠呼吸暂停的老年患者。方法和结果 这项横断面研究包括 450 名患有未确诊睡眠呼吸暂停的冠状动脉疾病患者，他们的左心室射血分数 50%，并在急性冠状动脉综合征治疗后两周内连续转诊至心血管康复诊所。分析了多导睡眠图和超声心动图测量结果。轻度至重度睡眠呼吸暂停定义为呼吸暂停-低通气指数5。年龄分为60岁以下和60岁以上。高达 35% 的冠状动脉疾病患者可能患有未确诊的睡眠呼吸暂停。睡眠呼吸暂停和年龄组对舒张功能的影响之间存在统计学上显着的交互作用，定义为舒张早期峰值流速/心房收缩峰值流速之比（p=0. 036）。中重度睡眠呼吸暂停组 (0.97, 95% 置信区间 0.88-1.06) 的这一比率显着 (p=0.029) 低于非睡眠呼吸暂停组 (1.09, 95% 置信区间 1.03-1.15)。老年（<60 岁）冠状动脉疾病患者。因此，患有睡眠呼吸暂停的中年（<60 岁）患者的填充模式类似于在没有睡眠呼吸暂停的老年（60 岁）患者中观察到的填充模式。未观察到睡眠呼吸暂停对老年人左心室充盈模式的影响。结论 年龄改变了睡眠呼吸暂停对心血管结局的影响。未确诊的睡眠呼吸暂停会损害中年冠状动脉疾病患者的舒张功能这一发现强调了早期诊断和治疗睡眠呼吸暂停的重要性。