短期間に冠動脈病変の進行を観察しえた睡眠時無呼吸症候群（SAS）の1例

Rapid Progression of Coronary Artery Lesions in a Patient with Sleep Apnea Syndrome: A case report

　睡眠時無呼吸症候群（SAS）と虚血性心疾患の関連が報告されているが，SASの経過観察中，比較的短期間に冠動脈病変の進行を観察し得たとする報告は未だみられない．症例は65歳，男性．1990年7月，胸痛の精査目的で入院．CAGにて有意狭窄を認めなかった．睡眠時の無呼吸を指摘されていたため終夜ポリソムノグラフィー（ANPSG）を施行しSASと診断した．1991年1月，心筋梗塞を発症し右冠動脈に完全閉塞を認めた．SASに対してはnasal CPAP（NCPAP）が著効することが確認されたが不快感のためほとんど使用されなかった．1992年8月より労作時胸痛が出現し，CAGでは新たに左前下行枝に99％狭窄が出現した．軽度の肥満と軽症高血圧以外に有意の冠危険因子は認めず，SASと短期間に進行した冠動脈病変との関連性が示唆された．

Several previous reports have indicated an associa-tion between sleep apnea syndrome (SAS) and ischemic heart disease. However, it is not known whether SAS facilitates the development of coronary artery lesion. This is the first case report describing rapid progression of a coronary artery lesion observed in a SAS patient. In June, 1990, a 65-year-old man complaining of atypical chest pain was admitted to our hospital. The result of clinical examination for ischemic heart disease includ-ing thallium myocardial scintigraphy and coronary artery angiography (CAG) revealed no significant coro-nary artery disease. We finally made a diagnosis of SAS because of the positive results of overnight polysomno-graphy showing an apnea index of 50 times/hour, and we instructed the patient mainly to control his body weight and his mild hypertension. In January, 1991, he suffered from acute myocardial infarction. CAG on admission demonstrated a total occlusion of his right coronary artery. Since this event, his chest pain has been controlled well with a calcium channel blocker, nitrates, and aspirin. However, his SAS had remained insufficiently treated. The nasal CPAP was found to be very effective for his SAS, but he refused its continuous use because of the unpleasant feeling he experienced when it was attached. In August, 1992, he was admmit-ted again because of a worsening type of chest pain on effort. CAG revealed a new lesion, 99% stenosis of his left anterior descending artery, which was subsequently treated by bypass grafting surgery. This case suggests that SAS may facilitate the progression of coronary artery lesion.