Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, 155 College Street, Suite 425, Toronto, ON, Canada M5T 3M6.
Graduate Department of Rehabilitation Science/Collaborative Program in Neuroscience, University of Toronto, Canada.
Sleep Med Rev. 2014 Feb;18(1):49-59. doi: 10.1016/j.smrv.2013.01.003. Epub 2013 May 1.
Reports on the association between obstructive sleep apnea (OSA) and risk of death, cardiovascular (CV) events, diabetes and depression have been inconsistent.
We conducted a systematic review of the prognostic value of clinical and polysomnographic (PSG) characteristics of OSA for adverse long-term outcomes of untreated OSA in adult patients. A comprehensive search strategy for prognosis studies, OSA, CV events, mortality, depression and diabetes was developed in collaboration with a medical information specialist. All English language studies, from Jan 1999 to Dec 2011, with longitudinal design in adults with OSA diagnosed by PSG recording, found through Medline, Embase and bibliographies of identified articles, were considered eligible. Quality was assessed using published guidelines.
Among 26 articles, ten evaluated the association of OSA with mortality, 9 with a composite CV outcome, 4 with stroke, 2 with diabetes and 1 with depression. Significant relationships between the apnea-hypopnea index (AHI) and outcomes of interest were reported in 18 studies: seven for all-cause mortality, six for composite CV events, three for stroke, one for diabetes and one for depression. The effect of AHI was attenuated by female gender, older age, absence of daytime sleepiness and higher body mass index. Due to clinical heterogeneity between studies, meta-analyses were not performed.
Evidence exists in men for a relationship between OSA and all-cause mortality and a composite CV outcome. Associations between OSA and other outcomes remain uncertain. Among OSA-specific markers, only AHI was a consistent predictor. Other consistent predictors were traditional CV risk factors. Research is required to identify effect modifiers and the predictive ability of various AHI threshold values and hypopnea definitions. An enhanced set of OSA-specific predictors will allow better risk stratification to guide OSA treatment.
关于阻塞性睡眠呼吸暂停（OSA）与死亡、心血管（CV）事件、糖尿病和抑郁症风险之间的关联的报告结果并不一致。
我们对未经治疗的 OSA 成年患者的临床和多导睡眠图（PSG）特征与不良预后之间的关联进行了系统评价。与医学信息专家合作制定了一项全面的预后研究、OSA、CV 事件、死亡率、抑郁和糖尿病的检索策略。纳入标准为：所有符合条件的研究均为 1999 年 1 月至 2011 年 12 月间发表的、采用 PSG 记录对 OSA 进行诊断的成年患者进行的前瞻性队列研究或回顾性病例对照研究，检索范围为 Medline、Embase 和纳入文献的参考文献，语言限定为英文。使用发表的指南对质量进行评估。
在 26 篇文章中，有 10 篇评估了 OSA 与死亡率之间的关系，9 篇评估了 CV 复合结局，4 篇评估了卒中，2 篇评估了糖尿病，1 篇评估了抑郁。18 项研究报告了 AHI 与感兴趣结局之间存在显著相关性：7 项研究报告了全因死亡率，6 项研究报告了 CV 复合事件，3 项研究报告了卒中，1 项研究报告了糖尿病，1 项研究报告了抑郁。在研究之间存在临床异质性的情况下，无法进行荟萃分析。
在男性中，OSA 与全因死亡率和 CV 复合结局之间存在关联的证据确凿。OSA 与其他结局之间的关联仍不确定。在 OSA 特异性标志物中，只有 AHI 是一致的预测因子。其他一致的预测因子为传统的 CV 危险因素。需要研究来确定调节因子以及各种 AHI 阈值和低通气定义的预测能力。增强的一组 OSA 特异性预测因子将能够更好地进行风险分层，以指导 OSA 治疗。
