Willich S N, Goldberg R J, Maclure M, Perriello L, Muller J E
Institute for Prevention of Cardiovascular Disease, Deaconess Hospital, Harvard Medical School, Boston, Massachusetts 02215.
Am J Cardiol. 1992 Jul 1;70(1):65-8. doi: 10.1016/0002-9149(92)91391-g.
A circadian variation of sudden cardiac death has been documented, but its relation to individual time of awakening and possible triggering events has not been studied in the general population. By monitoring of mortality records in 4 cities and towns in Massachusetts, 148 potential cases of sudden cardiac death were identified. In 94 cases, the informants listed on the death certificates were contacted, the diagnosis of sudden cardiac death was established, and a telephone interview was completed within a mean of 19 days (range 8 to 28) after the death. The time of day of all 94 cases of sudden cardiac death (mean age 61 +/- 9 years, 74% men) demonstrated a circadian variation (p less than 0.05) with a peak from 9:00 A.M. to 12:00 noon. An analysis of time of death adjusted for individual wake-times of the decedents demonstrated an increased onset of sudden cardiac death during the initial 3-hour interval after awakening with a relative risk of 2.6 (95% confidence interval 1.6, 4.2) compared with other times of the day. The increased risk of sudden cardiac death soon after awakening suggests specific triggering factors or mechanisms that are particularly likely to occur during this time. The narrowing of the time interval during which the risk of sudden cardiac death is increased should facilitate the study of possible pathogenetic mechanisms and triggering factors of the disease and may aid in the design of more effective preventive strategies.
心脏性猝死存在昼夜节律变化，但在普通人群中，其与个体醒来时间及可能的触发事件之间的关系尚未得到研究。通过监测马萨诸塞州4个城镇的死亡记录，确定了148例潜在的心脏性猝死病例。在94例病例中，联系了死亡证明上列出的 informant，确定了心脏性猝死的诊断，并在死亡后平均19天（范围8至28天）内完成了电话访谈。所有94例心脏性猝死病例（平均年龄61±9岁，74%为男性）的死亡时间呈现出昼夜节律变化（p<0.05），上午9:00至中午12:00达到峰值。对根据死者个体醒来时间调整后的死亡时间进行分析显示，与一天中的其他时间相比，醒来后的最初3小时内心脏性猝死的发病增加，相对风险为2.6（95%置信区间1.6,4.2）。醒来后不久心脏性猝死风险增加表明存在特定的触发因素或机制，这些因素或机制在此期间特别容易发生。心脏性猝死风险增加的时间间隔变窄应有助于研究该疾病可能的发病机制和触发因素，并可能有助于设计更有效的预防策略。
