Martínez-García Miguel Angel, Soler-Cataluña Juan José, Ejarque-Martínez Laura, Soriano Youssef, Román-Sánchez Pilar, Illa Ferrán Barbé, Canal Josep María Montserrat, Durán-Cantolla Joaquín
Unidad de Neumología, Hospital General de Requena, Paraje Casablanca s/n 46340,Valencia, Spain.
Am J Respir Crit Care Med. 2009 Jul 1;180(1):36-41. doi: 10.1164/rccm.200808-1341OC. Epub 2009 Apr 30.
Obstructive sleep apnea (OSA) is an independent risk factor for stroke, but little is known about the role of continuous positive airway pressure (CPAP) on mortality in patients with stroke.
To analyze the independent impact of long-term CPAP treatment on mortality in patients with ischemic stroke.
Prospective observational study in 166 patients with ischemic stroke. Sleep study was performed in all of them and CPAP treatment was offered in the case of moderate to severe cases. Patients were followed-up for 5 years to analyze the risk of mortality.
Of 223 patients consecutively admitted for stroke, a sleep study was performed on 166 of them (2 mo after the acute event). Thirty-one had an apnea-hypopnea index (AHI) of less than 10; 39 had an AHI between 10 and 19, and 96 had an AHI of 20 or greater. CPAP treatment was offered when AHI was 20 or greater. Patients were followed up in our outpatient clinic at 1, 3, and 6 months, and for every 6 months thereafter for 5 years (prospective observational study). Mortality data were recorded from our computer database and official death certificates. The mean age of subjects was 73.3 +/- 11 years (59% males), and the mean AHI was 26 (for all patients with a predominance of obstructive events). Patients with an AHI of 20 or greater who did not tolerate CPAP (n = 68) showed an increase adjusted risk of mortality (hazards ratio [HR], 2.69; 95% confidence interval [CI], 1.32-5.61) compared with patients with an AHI of less than 20 (n = 70), and an increased adjusted risk of mortality (HR, 1.58; 95% CI, 1.01-2.49; P = 0.04) compared with patients with moderate to severe OSA who tolerated CPAP (n = 28). There were no differences in mortality among patients without OSA, patients with mild disease, and patients who tolerated CPAP.
Our results suggest that long-term CPAP treatment in moderate to severe OSA and ischemic stroke is associated with a reduction in excess risk of mortality.
阻塞性睡眠呼吸暂停（OSA）是中风的一个独立危险因素，但关于持续气道正压通气（CPAP）对中风患者死亡率的作用知之甚少。
分析长期CPAP治疗对缺血性中风患者死亡率的独立影响。
对166例缺血性中风患者进行前瞻性观察研究。对所有患者进行睡眠研究，中重度病例给予CPAP治疗。对患者进行5年随访以分析死亡风险。
在连续收治的223例中风患者中，对其中166例（急性事件后2个月）进行了睡眠研究。31例呼吸暂停低通气指数（AHI）小于10；39例AHI在10至19之间，96例AHI为20或更高。当AHI为20或更高时给予CPAP治疗。患者在1、3和6个月时在我们的门诊进行随访，此后每6个月随访一次，共5年（前瞻性观察研究）。死亡数据从我们的计算机数据库和官方死亡证明中记录。受试者的平均年龄为73.3±11岁（59%为男性），平均AHI为26（所有患者以阻塞性事件为主）。与AHI小于20的患者（n = 70）相比，AHI为20或更高且不耐受CPAP的患者（n = 68）调整后的死亡风险增加（风险比[HR]，2.69；95%置信区间[CI]，1.32 - 5.61），与中度至重度OSA且耐受CPAP的患者（n = 28）相比，调整后的死亡风险也增加（HR，1.58；95% CI，1.01 - 2.49；P = 0.04）。无OSA的患者、轻度疾病患者和耐受CPAP的患者之间死亡率无差异。
我们的结果表明，对中度至重度OSA和缺血性中风患者进行长期CPAP治疗与降低额外死亡风险相关。
