持续气道正压通气或口腔矫治器治疗阻塞性睡眠呼吸暂停患者的心血管死亡率：一项观察性研究。

Cardiovascular mortality in obstructive sleep apnoea treated with continuous positive airway pressure or oral appliance: an observational study.

机构信息

Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Department of Social and Preventive Medicine, Western New York Respiratory Research Center, Buffalo, New York, USA; School of Medicine and Biomedical Sciences, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, New York, USA.

出版信息

Respirology. 2013 Nov;18(8):1184-90. doi: 10.1111/resp.12140.

DOI:10.1111/resp.12140

PMID:23731062

Abstract

BACKGROUND AND OBJECTIVE

The objective of this study was to evaluate the long-term cardiovascular mortality in patients with severe obstructive sleep apnoea (OSA) treated with either continuous positive airway pressure (CPAP) or mandibular advancing device (MAD).

METHODS

A non-concurrent cohort study of 570 subjects with severe OSA (apnoea/hypopnoea index (AHI) ≥ 30/h) and a control group of 269 subjects (AHI < 5/h) were followed up for a median of 79 months (interquartile range 76-88 months). All patients received CPAP initially. MAD was offered for those who were non-adherent to CPAP. The endpoint was cardiovascular death.

RESULTS

Two hundred and eight control subjects, 177 patients treated with CPAP, 72 with MAD and 212 who declined treatment were analysed. Forty-two patients had a fatal cardiovascular event during the course of the study. The non-apnoeic group had the lowest cardiovascular death rate (0.28 per 100 person-years (95% confidence interval (CI): 0.08-0.71)) followed by the CPAP-treated (0.56 per 100 person-years (95% CI: 0.20-1.23)) and the MAD-treated OSA group (0.61 per 100 person-years (95% CI: 0.13-1.78)), with the highest cardiovascular mortality rate observed in the untreated OSA group (2.1 per 100 person-years (95% CI: 1.37-2.92)). Although residual AHI for MAD-treated patients was significantly higher than CPAP-treated patients (16.3 ± 5.1/h vs. 4.5 ± 2.3/h; P < 0.001), there was no difference in cardiovascular death rate between the two groups (hazard ratio 1.08 (95% CI: 0.55-1.74); P = 0.71).

CONCLUSIONS

Both CPAP and MAD may be equally effective therapy in reducing the risk of fatal cardiovascular events in patients with severe OSA.

摘要

背景和目的

本研究旨在评估重度阻塞性睡眠呼吸暂停（OSA）患者接受持续气道正压通气（CPAP）或下颌前伸装置（MAD）治疗后的长期心血管死亡率。

方法

对 570 例重度 OSA 患者（呼吸暂停/低通气指数（AHI）≥30/h）和 269 例对照组患者（AHI＜5/h）进行非同期队列研究，中位随访时间为 79 个月（四分位距 76-88 个月）。所有患者最初均接受 CPAP 治疗。对于 CPAP 治疗不依从的患者，提供 MAD 治疗。终点为心血管死亡。

结果

208 例对照组、177 例 CPAP 治疗组、72 例 MAD 治疗组和 212 例拒绝治疗组患者进行了分析。研究过程中共有 42 例患者发生致命心血管事件。无呼吸暂停组的心血管死亡率最低（0.28/100 人年（95%置信区间（CI）：0.08-0.71）），其次是 CPAP 治疗组（0.56/100 人年（95%CI：0.20-1.23））和 MAD 治疗组（0.61/100 人年（95%CI：0.13-1.78）），未治疗 OSA 组的心血管死亡率最高（2.1/100 人年（95%CI：1.37-2.92））。尽管 MAD 治疗组患者的残余 AHI 明显高于 CPAP 治疗组（16.3±5.1/h 比 4.5±2.3/h；P＜0.001），但两组心血管死亡率无差异（风险比 1.08（95%CI：0.55-1.74）；P=0.71）。