Sleepcare Diagnostics, Cincinnati, OH 45040, USA.
Am J Respir Crit Care Med. 2011 Feb 15;183(4):539-46. doi: 10.1164/rccm.201003-0406OC. Epub 2010 Jul 23.
Previous studies have demonstrated a high prevalence of sleep apnea (SA) in patients with chronic heart failure (HF), which is associated with higher rates of morbidity, mortality, and health care use.
To investigate the reported incidence, treatment, outcomes, and economic cost of SA in new-onset HF in a large U.S. database.
This retrospective cohort study used the 2003 to 2005 Medicare Standard Analytical Files and included subjects with newly diagnosed HF from the first quarter of 2004, without prior diagnosis of SA, stratified by testing, diagnosis, and treatment status.
Among a study population of 30,719 incident subjects with HF, only 1,263 (4%) were clinically suspected to have SA. Of these, 553 (2% of the total cohort) received SA testing, and 545 received treatment. After adjustment for age, sex, and comorbidities, subjects with HF who were tested, diagnosed, and treated for SA had a better 2-year survival rate compared with subjects with HF who were not tested (hazard ratio, 0.33 [95% confidence interval, 0.21-0.51], P < 0.0001). Similarly, among subjects who were tested and diagnosed, those who were treated had a better 2-year survival rate than those who were not treated (hazard ratio, 0.49 [95% confidence interval, 0.29-0.84], P = 0.009).
In Medicare beneficiaries with HF, comorbid SA is most often not tested and consequently subjects are underdiagnosed and not treated. Meanwhile, in the few subjects in whom a diagnosis of SA is established and treatment is executed, survival improves significantly. These results support the importance of SA testing and treatment for patients newly diagnosed with HF.
先前的研究表明，慢性心力衰竭（HF）患者中睡眠呼吸暂停（SA）的患病率很高，这与发病率、死亡率和医疗保健利用率较高有关。
在一个大型美国数据库中，调查新诊断的 HF 患者中 SA 的报告发病率、治疗、结局和经济成本。
这项回顾性队列研究使用了 2003 年至 2005 年 Medicare 标准分析文件，并纳入了 2004 年第一季度首次诊断为 HF 且无 SA 既往诊断的患者，按检测、诊断和治疗情况分层。
在 30719 例新诊断 HF 的研究人群中，仅有 1263 例（4%）临床疑似患有 SA。其中，553 例（占总队列的 2%）接受了 SA 检测，545 例接受了治疗。在调整年龄、性别和合并症后，接受 SA 检测、诊断和治疗的 HF 患者的 2 年生存率高于未接受检测的 HF 患者（风险比，0.33 [95%置信区间，0.21-0.51]，P<0.0001）。同样，在接受检测和诊断的患者中，接受治疗的患者的 2 年生存率高于未接受治疗的患者（风险比，0.49 [95%置信区间，0.29-0.84]，P=0.009）。
在 Medicare 受益人群中，HF 合并症 SA 最常未被检测到，因此患者的诊断不足且未得到治疗。同时，在少数确诊为 SA 并接受治疗的患者中，生存率显著提高。这些结果支持对新诊断的 HF 患者进行 SA 检测和治疗的重要性。
