Association between coronary plaque characteristics and sleep disordered breathing

2018 Fiscal Year Final Research Report

• Project/Area Number: 16K19431
• Research Category: Grant-in-Aid for Young Scientists (B)
• Allocation Type: Multi-year Fund
• Research Field: Cardiovascular medicine
• Research Institution: Juntendo University
• Principal Investigator: Dohi Tomotaka 順天堂大学, 医学部, 准教授 (50771755)
• Project Period (FY): 2016-04-01 – 2019-03-31
• Keywords: 睡眠呼吸障害 / 冠動脈硬化 / 血管内超音波 / 不安定プラーク / 残余リスク / 睡眠時無呼吸症候群 / 経鼻的持続陽圧呼吸療法

Outline of Final Research Achievements

Our intravascular ultrasound analysis showed significant association between sleep-disordered breathing (SDB) and coronary plaque vulnerability. This study included 289 patients with coronary artery disease. Plaque characteristics of the culprit lesion were assessed by preintervention intravascular ultrasound. The presence of SDB was defined as a 3% oxygen desaturation index of >15 events per hour measured by nocturnal pulse oximetry. Attenuated plaque with a maximum attenuation angle >140 degree was more frequently observed in the SDB group compared with the no-SDB group (34.9% versus 22.6%; P=0.03). Multivariable logistic regression analysis showed that the presence of SDB was a significant predictor of a greater ultrasound attenuation angle (>140 degree) (odds ratio, 1.86; 95% confidence interval, 1.02 to 3.39; P=0.04). SDB was associated with larger atheroma plaque volume and a greater ultrasound attenuation, which are discriminators of plaque vulnerability.

Free Research Field

動脈硬化

Academic Significance and Societal Importance of the Research Achievements

睡眠呼吸障害の存在が、冠動脈疾患患者におけるプラークの不安定性に関わることを解明したことで、睡眠呼吸障害が冠動脈疾患リスクであることの再認識と治療介入への期待を示唆したと考える。つまり、高血圧症や脂質異常症などの古典的リスクだけでなく、睡眠呼吸障害のスクリーニングの重要性やそれに対する治療アプローチが厳格な冠動脈疾患2次予防戦略のひとつになる可能性があるからである。今後の課題として、睡眠呼吸障害への治療介入が冠動脈硬化の進展予防効果があるかどうか、心筋梗塞や狭心症の発症が抑制できるかなどが検証されるべきである。