老年阻塞性睡眠呼吸暂停患者的心血管死亡率：长期持续气道正压通气治疗的作用：一项前瞻性观察研究。

Cardiovascular mortality in obstructive sleep apnea in the elderly: role of long-term continuous positive airway pressure treatment: a prospective observational study.

机构信息

Pneumology Service, La Fe University and Polytechnic Hospital, Bulevar Sur s/n, Valencia, Spain.

出版信息

Am J Respir Crit Care Med. 2012 Nov 1;186(9):909-16. doi: 10.1164/rccm.201203-0448OC. Epub 2012 Sep 13.

DOI:10.1164/rccm.201203-0448OC

PMID:22983957

Abstract

RATIONALE

Obstructive sleep apnea (OSA) is a risk factor for cardiovascular death in middle-aged subjects, but it is not known whether it is also a risk factor in the elderly.

OBJECTIVES

To investigate whether OSA is a risk factor for cardiovascular death and to assess whether continuous positive airway pressure (CPAP) treatment is associated with a change in risk in the elderly.

METHODS

Prospective, observational study of a consecutive cohort of elderly patients (≥65 yr) studied for suspicion of OSA between 1998 and 2007. Patients with an apnea-hypopnea index (AHI) less than 15 were the control group. OSA was defined as mild to moderate (AHI, 15-29) or severe (AHI, ≥30). Patients with OSA were classified as CPAP-treated (adherence ≥ 4 h/d) or untreated (adherence < 4 h/d or not prescribed). Participants were monitored until December 2009. The end point was cardiovascular death. A multivariate Cox survival analysis was used to determine the independent impact of OSA and CPAP treatment on cardiovascular mortality.

MEASUREMENTS AND MAIN RESULTS

A total of 939 elderly were studied (median follow-up, 69 mo). Compared with the control group, the fully adjusted hazard ratios for cardiovascular mortality were 2.25 (confidence interval [CI], 1.41 to 3.61) for the untreated severe OSA group, 0.93 (CI, 0.46 to 1.89) for the CPAP-treated group, and 1.38 (CI, 0.73 to 2.64) for the untreated mild to moderate OSA group.

CONCLUSIONS

Severe OSA not treated with CPAP is associated with cardiovascular death in the elderly, and adequate CPAP treatment may reduce this risk.

摘要

背景

阻塞性睡眠呼吸暂停（OSA）是中年患者心血管死亡的一个危险因素，但它是否也是老年人的一个危险因素尚不清楚。

目的

研究 OSA 是否是心血管死亡的一个危险因素，并评估持续气道正压通气（CPAP）治疗是否与老年人风险的变化相关。

方法

对 1998 年至 2007 年间因疑似 OSA 而接受研究的连续队列老年患者（≥65 岁）进行前瞻性、观察性研究。呼吸暂停低通气指数（AHI）<15 的患者为对照组。OSA 定义为轻度至中度（AHI，15-29）或重度（AHI，≥30）。将 OSA 患者分为 CPAP 治疗（依从性≥4 h/d）或未治疗（依从性<4 h/d 或未开处方）。参与者监测至 2009 年 12 月。终点是心血管死亡。使用多变量 Cox 生存分析来确定 OSA 和 CPAP 治疗对心血管死亡率的独立影响。

测量和主要结果

共研究了 939 名老年人（中位随访时间，69 个月）。与对照组相比，未经治疗的重度 OSA 组的心血管死亡风险比为 2.25（置信区间[CI]，1.41 至 3.61），CPAP 治疗组为 0.93（CI，0.46 至 1.89），未经治疗的轻度至中度 OSA 组为 1.38（CI，0.73 至 2.64）。