阻塞性睡眠呼吸暂停作为中风和死亡的危险因素。

Obstructive sleep apnea as a risk factor for stroke and death.

作者信息

Yaggi H Klar, Concato John, Kernan Walter N, Lichtman Judith H, Brass Lawrence M, Mohsenin Vahid

机构信息

Section of Pulmonary and Critical Care Medicine, Yale Center for Sleep Medicine, Yale University School of Medicine, New Haven, Conn 06520, USA.

出版信息

N Engl J Med. 2005 Nov 10;353(19):2034-41. doi: 10.1056/NEJMoa043104.

DOI:10.1056/NEJMoa043104

PMID:16282178

Abstract

BACKGROUND

Previous studies have suggested that the obstructive sleep apnea syndrome may be an important risk factor for stroke. It has not been determined, however, whether the syndrome is independently related to the risk of stroke or death from any cause after adjustment for other risk factors, including hypertension.

METHODS

In this observational cohort study, consecutive patients underwent polysomnography, and subsequent events (strokes and deaths) were verified. The diagnosis of the obstructive sleep apnea syndrome was based on an apnea-hypopnea index of 5 or higher (five or more events per hour); patients with an apnea-hypopnea index of less than 5 served as the comparison group. Proportional-hazards analysis was used to determine the independent effect of the obstructive sleep apnea syndrome on the composite outcome of stroke or death from any cause.

RESULTS

Among 1022 enrolled patients, 697 (68 percent) had the obstructive sleep apnea syndrome. At baseline, the mean apnea-hypopnea index in the patients with the syndrome was 35, as compared with a mean apnea-hypopnea index of 2 in the comparison group. In an unadjusted analysis, the obstructive sleep apnea syndrome was associated with stroke or death from any cause (hazard ratio, 2.24; 95 percent confidence interval, 1.30 to 3.86; P=0.004). After adjustment for age, sex, race, smoking status, alcohol-consumption status, body-mass index, and the presence or absence of diabetes mellitus, hyperlipidemia, atrial fibrillation, and hypertension, the obstructive sleep apnea syndrome retained a statistically significant association with stroke or death (hazard ratio, 1.97; 95 percent confidence interval, 1.12 to 3.48; P=0.01). In a trend analysis, increased severity of sleep apnea at baseline was associated with an increased risk of the development of the composite end point (P=0.005).

CONCLUSIONS

The obstructive sleep apnea syndrome significantly increases the risk of stroke or death from any cause, and the increase is independent of other risk factors, including hypertension.

摘要

背景

先前的研究表明，阻塞性睡眠呼吸暂停综合征可能是中风的一个重要危险因素。然而，在对包括高血压在内的其他危险因素进行调整后，该综合征是否与中风风险或任何原因导致的死亡独立相关尚未确定。

方法

在这项观察性队列研究中，连续的患者接受了多导睡眠图检查，并对随后发生的事件（中风和死亡）进行了核实。阻塞性睡眠呼吸暂停综合征的诊断基于呼吸暂停低通气指数为5或更高（每小时5次或更多事件）；呼吸暂停低通气指数小于5的患者作为对照组。采用比例风险分析来确定阻塞性睡眠呼吸暂停综合征对中风或任何原因导致的死亡这一复合结局的独立影响。

结果

在1022名登记患者中，697名（68%）患有阻塞性睡眠呼吸暂停综合征。在基线时，该综合征患者的平均呼吸暂停低通气指数为35，而对照组的平均呼吸暂停低通气指数为2。在未调整的分析中，阻塞性睡眠呼吸暂停综合征与中风或任何原因导致的死亡相关（风险比，2.24；95%置信区间，1.30至3.86；P = 0.004）。在对年龄、性别、种族、吸烟状况、饮酒状况、体重指数以及是否存在糖尿病、高脂血症、心房颤动和高血压进行调整后，阻塞性睡眠呼吸暂停综合征与中风或死亡仍保持统计学上的显著关联（风险比，1.97；95%置信区间，1.12至3.48；P = 0.01）。在趋势分析中，基线时睡眠呼吸暂停严重程度的增加与复合终点发生风险的增加相关（P = 0.005）。