UCSF Sleep Disorders Center, University of California,San Francisco, CA, USA.
Sleep Breath. 2013 Mar;17(1):85-91. doi: 10.1007/s11325-012-0653-y.
We hypothesized that obstructive sleep apnea(OSA) has a dose-dependent impact on mortality in those with ischemic heart disease or previous myocardial injury.
We performed a retrospective cohort study of 281 consecutive OSA patients with a history of myocardial injury as determined by elevated troponin levels or with known existing ischemic heart disease. We compared survival between those with severe OSA [apnea–hypopneaindex (AHI) ≥30] and those with mild to moderate OSA(AHI >5 and <30).
Of the 281 patients (mean age 65 years, mean BMI34, 98% male, 58% with diabetes), 151 patients had mild moderate OSA and 130 had severe OSA. During a mean follow-up of 4.1 years, there were significantly greater deaths in the severe OSA group compared to the mild moderate OSA group [53 deaths (41%) vs. 44 deaths(29%), respectively, p00.04]. The adjusted hazard ratio for mortality with severe OSA was 1.72 (95% confidence interval1.01–2.91, p00.04).
The severity of obstructive sleep apnea is associated with increased risk of death, and risk stratification based on OSA severity is relevant even in the diseased cardiac patient.
我们假设阻塞性睡眠呼吸暂停（OSA）对有缺血性心脏病或既往心肌损伤的患者的死亡率有剂量依赖性影响。
我们对 281 例连续的 OSA 患者进行了回顾性队列研究，这些患者的心肌损伤史由升高的肌钙蛋白水平或已知的现有缺血性心脏病确定。我们比较了严重 OSA（呼吸暂停-低通气指数[AHI]≥30）和轻度至中度 OSA（AHI＞5 且＜30）患者之间的生存情况。
在 281 例患者（平均年龄 65 岁，平均 BMI34，98%为男性，58%患有糖尿病）中，151 例患者有轻度至中度 OSA，130 例患者有严重 OSA。在平均 4.1 年的随访期间，严重 OSA 组的死亡人数明显多于轻度至中度 OSA 组[53 例死亡（41%）比 44 例死亡（29%），分别，p00.04]。严重 OSA 患者的死亡调整风险比为 1.72（95%置信区间 1.01-2.91，p00.04）。
阻塞性睡眠呼吸暂停的严重程度与死亡风险增加相关，即使在患病心脏患者中，基于 OSA 严重程度的风险分层也是相关的。
