Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; CIBER Enfermedades Respiratorias (CIBERES), Spain.
Int J Cardiol. 2013 Sep 30;168(2):1328-35. doi: 10.1016/j.ijcard.2012.12.015. Epub 2013 Jan 7.
Obstructive sleep apnea (OSA) is linked to increased cardiovascular risk, but the association between OSA and myocardial infarction (MI) remains controversial. Our objectives were to compare the frequency of OSA in patients with acute MI and in a population-based sample of control subjects, and to evaluate the impact of CPAP on recurrent MI and coronary revascularization.
Case-control study with a 6-year follow-up of the case cohort. 192 acute MI patients and 96 matched control subjects without coronary artery disease (CAD) (ratio 2:1). After overnight polysomnography, CPAP was recommended if apnea-hypopnea index (AHI) ≥ 5, and a mean daily use >3.5h/day was considered necessary to maintain the treatment. Lipids, fasting glucose, blood pressure, spirometry, comorbidity and current treatment were also registered. End-points were recurrent MI or need of revascularization.
OSA was an independent predictor of MI, with odds ratio 4.9 (95% confidence interval [CI] 2.9-8.3, p=0.017). 63 MI patients without OSA, 52 untreated patients with OSA and 71 OSA patients treated with CPAP were included in the follow-up study. After adjustment for confounding factors, treated OSA patients had a lower risk of recurrent MI (adjusted hazard ratio 0.16 [95%CI 0.03-0.76, p=0.021]) and revascularization (adjusted hazard ratio 0.15 [95%CI 0.03-0.79, p=0.025]) than untreated OSA patients, and similar to non-OSA patients.
Mild-severe OSA is an independent risk factor for MI. Risk of recurrent MI and revascularization was lower in OSA patients who tolerated CPAP.
阻塞性睡眠呼吸暂停（OSA）与心血管风险增加有关，但 OSA 与心肌梗死（MI）之间的关联仍存在争议。我们的目的是比较急性 MI 患者和基于人群的对照组中 OSA 的频率，并评估 CPAP 对复发性 MI 和冠状动脉血运重建的影响。
对病例队列进行了为期 6 年的病例对照研究。192 名急性 MI 患者和 96 名无冠状动脉疾病（CAD）的匹配对照组（比例为 2:1）。如果呼吸暂停低通气指数（AHI）≥5，则进行整夜多导睡眠图检查，如果平均每日使用>3.5 小时/天，则建议使用 CPAP，并认为需要维持治疗。还记录了血脂、空腹血糖、血压、肺功能、合并症和当前治疗情况。终点是复发性 MI 或需要血运重建。
OSA 是 MI 的独立预测因素，优势比为 4.9（95%置信区间[CI]为 2.9-8.3，p=0.017）。在随访研究中，纳入了 63 名无 OSA 的 MI 患者、52 名未经治疗的 OSA 患者和 71 名接受 CPAP 治疗的 OSA 患者。调整混杂因素后，治疗后的 OSA 患者发生复发性 MI（调整后的危险比为 0.16 [95%CI 为 0.03-0.76，p=0.021]）和血运重建（调整后的危险比为 0.15 [95%CI 为 0.03-0.79，p=0.025]）的风险低于未治疗的 OSA 患者，与非 OSA 患者相似。
轻度至重度 OSA 是 MI 的独立危险因素。对 CPAP 耐受的 OSA 患者，复发性 MI 和血运重建的风险较低。
