Impact of Obstructive Sleep Apnea Syndrome on The Clinical Course of Ischemic Heart Disease and Patients’ Quality of Life

Authors

Zulfiya M. Shoalimova

PhD (Candidate of Medical Sciences), Associate Professor, Department of Internal Diseases and Fundamentals of Preventive Medicine in Family Medicine No. 1, Tashkent State Medical University, Tashkent, Uzbekistan
Khayrillo S. Rajabov

PhD, Republican Specialized Scientific and Practical Medical Center of Phthisiology and Pulmonology named after Academician Sh. Alimov, Tashkent, Uzbekistan
Zakhro Sharofiddinova

Third-Year Master’s Student in Cardiology, Tashkent State Medical University, Tashkent, Uzbekistan

DOI:

https://doi.org/10.37547/ijmscr/Volume06Issue11-03

Keywords:

Obstructive sleep apnea syndrome ischemic heart disease cardiorespiratory monitoring

Abstract

Background. Obstructive sleep apnea syndrome (OSAS) frequently coexists with ischemic heart disease (IHD), but its contribution to nocturnal arrhythmias and to the quality of life of these patients is not well defined. Sleep laboratories are scarce in Uzbekistan, so simpler screening methods are needed.

Aim. To determine the association between OSAS and cardiac rhythm and conduction disturbances, to assess its effect on the clinical course and quality of life of patients with IHD, and to evaluate RR-interval dynamics, rheopneumography (RPG) and pulse oximetry as screening tools for apnea.

Methods. Eighty-one hospitalized patients (63 men and 18 women aged 37–80 years, mean age 57.1 ± 2.3 years) with clinical features suggestive of sleep apnea underwent 24-hour cardiorespiratory monitoring that combined 12-lead electrocardiography, single-channel RPG, pulse oximetry, nasal airflow and snoring recording. Quality of life was assessed with the WHOQOL-BREF and a sleep apnea–specific questionnaire based on the Calgary Sleep Apnea Quality of Life Index (SAQLI).

Results. OSAS was diagnosed in 52 patients (64%): mild in 21, moderate in 11 and severe in 20. Of 25 patients with nocturnal rhythm or conduction disturbances, 18 (72%) had arrhythmias linked to apnea episodes, most often pauses caused by sinoatrial (7 patients) or atrioventricular (5 patients) block; 92% of all recorded pauses occurred during apnea. The longest asystole (7.9 s) was recorded in a patient with mild OSAS. Nine patients (11%) had asystole-related arrhythmias that required consideration of pacemaker implantation. Pulse oximetry had a sensitivity of 0.56 and a specificity of 0.96 for apnea episodes; RPG detected 79% of episodes with a specificity of 0.85. In patients with chronic heart failure, the mean SAQLI score was 3.1 ± 1.2 with a high apnea–hypopnea index (AHI) and 4.7 ± 0.3 with a low AHI (p < 0.01).

Conclusions. Most nocturnal rhythm and conduction disturbances in patients with IHD are associated with apnea, and severe pauses can occur regardless of OSAS severity. Patients with nocturnal pauses should be evaluated for sleep-disordered breathing. RPG is the most sensitive of the screening methods studied, and OSAS has the strongest negative effect on quality of life in patients with heart failure.

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