老年男性阻塞性和中枢性睡眠呼吸障碍谱中的夜间心律失常：老年男性睡眠障碍结局（MrOS睡眠）研究
Nocturnal Arrhythmias across a spectrum of obstructive and central sleep-disordered breathing in older men: outcomes of sleep disorders in older men (MrOS sleep) study.
作者信息
Mehra Reena, Stone Katie L, Varosy Paul D, Hoffman Andrew R, Marcus Gregory M, Blackwell Terri, Ibrahim Osama A, Salem Rawan, Redline Susan
机构信息
Departmentof Medicine, Division of Pulmonary, Case Western Reserve University School of Medicine, Center for Clinical Investigatio, Cleveland, Ohio 44106-6003, USA.
出版信息
Arch Intern Med. 2009 Jun 22;169(12):1147-55. doi: 10.1001/archinternmed.2009.138.
BACKGROUND
Rates of cardiac arrhythmias increase with age and may be associated with clinically significant morbidity. We studied the association between sleep-disordered breathing (SDB) with nocturnal atrial fibrillation or flutter (AF) and complex ventricular ectopy (CVE) in older men.
METHODS
A total of 2911 participants in the Outcomes of Sleep Disorders in Older Men Study underwent unattended polysomnography. Nocturnal AF and CVE were ascertained by electrocardiogram-specific analysis of the polysomnographic data. Exposures were (1) SDB defined by respiratory disturbance index (RDI) quartile (a major index including all apneas and hypopneas), and ancillary definitions incorporating (2) obstructive events, obstructive sleep apnea (OSA; Obstructive Apnea Hypopnea Index quartile), or (3) central events, central sleep apnea (CSA; Central Apnea Index category), and (4) hypoxia (percentage of sleep time with <90% arterial oxygen percent saturation). Multivariable logistic regression analyses were performed.
RESULTS
An increasing RDI quartile was associated with increased odds of AF and CVE (P values for trend, .01 and <.001, respectively). The highest RDI quartile was associated with increased odds of AF (odds ratio [OR], 2.15; 95% confidence interval [CI], 1.19-3.89) and CVE (OR, 1.43; 95% CI, 1.12-1.82) compared with the lowest quartile. An increasing OSA quartile was significantly associated with increasing CVE (P value for trend, .01) but not AF. Central sleep apnea was more strongly associated with AF (OR, 2.69; 95% CI, 1.61-4.47) than CVE (OR, 1.27; 95% CI, 0.97-1.66). Hypoxia level was associated with CVE (P value for trend, <.001); those in the highest hypoxia category had an increased odds of CVE (OR, 1.62; 95% CI, 1.23-2.14) compared with the lowest quartile.
CONCLUSIONS
In this large cohort of older men, increasing severity of SDB was associated with a progressive increase in odds of AF and CVE. When SDB was characterized according to central or obstructive subtypes, CVE was associated most strongly with OSA and hypoxia, whereas AF was most strongly associated with CSA, suggesting that different sleep-related stresses may contribute to atrial and ventricular arrhythmogenesis in older men.
背景
心律失常的发生率随年龄增长而增加，且可能与具有临床意义的发病率相关。我们研究了老年男性睡眠呼吸紊乱（SDB）与夜间房颤或房扑（AF）以及复杂性室性早搏（CVE）之间的关联。
方法
共有2911名老年男性睡眠障碍研究结果参与者接受了无人值守的多导睡眠图检查。通过对多导睡眠图数据进行心电图特异性分析来确定夜间房颤和CVE。暴露因素包括：（1）根据呼吸紊乱指数（RDI）四分位数定义的SDB（一个包括所有呼吸暂停和低通气的主要指标），以及纳入（2）阻塞性事件、阻塞性睡眠呼吸暂停（OSA；阻塞性呼吸暂停低通气指数四分位数）或（3）中枢性事件、中枢性睡眠呼吸暂停（CSA；中枢性呼吸暂停指数类别），和（4）低氧血症（动脉血氧饱和度<90%的睡眠时间百分比）的辅助定义。进行了多变量逻辑回归分析。
结果
RDI四分位数增加与房颤和CVE的几率增加相关（趋势P值分别为.01和<.001）。与最低四分位数相比，最高RDI四分位数与房颤几率增加相关（优势比[OR]，2.15；95%置信区间[CI]，1.19 - 3.89）和CVE几率增加相关（OR，1.43；95% CI，1.12 - 1.82）。OSA四分位数增加与CVE增加显著相关（趋势P值为.01），但与房颤无关。中枢性睡眠呼吸暂停与房颤的相关性更强（OR，2.69；95% CI，1.61 - 4.47），而与CVE的相关性较弱（OR，1.27；95% CI，0.97 - 1.66）。低氧血症水平与CVE相关（趋势P值<.001）；与最低四分位数相比，处于最高低氧血症类别的人群CVE几率增加（OR，1.62；95% CI，1.23 - 2.14）。
结论
在这个大型老年男性队列中，SDB严重程度增加与房颤和CVE几率的逐渐增加相关。当根据中枢性或阻塞性亚型对SDB进行特征化时，CVE与OSA和低氧血症的相关性最强，而房颤与CSA相关性最强，这表明不同的睡眠相关应激因素可能导致老年男性心房和心室心律失常的发生。
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