Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada ; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada ; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada ; Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
PLoS Med. 2014 Feb 4;11(2):e1001599. doi: 10.1371/journal.pmed.1001599. eCollection 2014 Feb.
Obstructive sleep apnea (OSA) has been reported to be a risk factor for cardiovascular (CV) disease. Although the apnea-hypopnea index (AHI) is the most commonly used measure of OSA, other less well studied OSA-related variables may be more pathophysiologically relevant and offer better prediction. The objective of this study was to evaluate the relationship between OSA-related variables and risk of CV events.
A historical cohort study was conducted using clinical database and health administrative data. Adults referred for suspected OSA who underwent diagnostic polysomnography at the sleep laboratory at St Michael's Hospital (Toronto, Canada) between 1994 and 2010 were followed through provincial health administrative data (Ontario, Canada) until May 2011 to examine the occurrence of a composite outcome (myocardial infarction, stroke, congestive heart failure, revascularization procedures, or death from any cause). Cox regression models were used to investigate the association between baseline OSA-related variables and composite outcome controlling for traditional risk factors. The results were expressed as hazard ratios (HRs) and 95% CIs; for continuous variables, HRs compare the 75th and 25th percentiles. Over a median follow-up of 68 months, 1,172 (11.5%) of 10,149 participants experienced our composite outcome. In a fully adjusted model, other than AHI OSA-related variables were significant independent predictors: time spent with oxygen saturation <90% (9 minutes versus 0; HR = 1.50, 95% CI 1.25-1.79), sleep time (4.9 versus 6.4 hours; HR = 1.20, 95% CI 1.12-1.27), awakenings (35 versus 18; HR = 1.06, 95% CI 1.02-1.10), periodic leg movements (13 versus 0/hour; HR = 1.05, 95% CI 1.03-1.07), heart rate (70 versus 56 beats per minute [bpm]; HR = 1.28, 95% CI 1.19-1.37), and daytime sleepiness (HR = 1.13, 95% CI 1.01-1.28).The main study limitation was lack of information about continuous positive airway pressure (CPAP) adherence.
OSA-related factors other than AHI were shown as important predictors of composite CV outcome and should be considered in future studies and clinical practice.
阻塞性睡眠呼吸暂停（OSA）已被报道为心血管（CV）疾病的危险因素。虽然呼吸暂停低通气指数（AHI）是最常用于衡量 OSA 的指标，但其他研究较少的与 OSA 相关的变量可能在病理生理学上更相关，并提供更好的预测。本研究的目的是评估与 OSA 相关的变量与 CV 事件风险之间的关系。
这是一项使用临床数据库和健康管理数据进行的历史性队列研究。1994 年至 2010 年间，在加拿大安大略省圣迈克尔医院（多伦多）的睡眠实验室接受疑似 OSA 诊断性多导睡眠图检查的成年人，通过省级健康管理数据（加拿大安大略省）进行随访，直到 2011 年 5 月，以检查复合结局（心肌梗死、中风、充血性心力衰竭、血运重建或任何原因导致的死亡）的发生。Cox 回归模型用于研究基线 OSA 相关变量与复合结局之间的关联，控制传统危险因素。结果以风险比（HR）和 95%置信区间（CI）表示；对于连续变量，HR 比较第 75 和第 25 百分位数。在中位数为 68 个月的随访中，10149 名参与者中有 1172 名（11.5%）发生了我们的复合结局。在完全调整后的模型中，除了 AHI，其他与 OSA 相关的变量都是显著的独立预测因素：血氧饱和度<90%的时间（9 分钟与 0 分钟；HR=1.50，95%CI 1.25-1.79）、睡眠时间（4.9 小时与 6.4 小时；HR=1.20，95%CI 1.12-1.27）、觉醒次数（35 次与 18 次；HR=1.06，95%CI 1.02-1.10）、周期性肢体运动（13 次与 0 次/小时；HR=1.05，95%CI 1.03-1.07）、心率（70 次与 56 次/分钟[bpm]；HR=1.28，95%CI 1.19-1.37）和白天嗜睡（HR=1.13，95%CI 1.01-1.28）。研究的主要局限性是缺乏关于持续气道正压通气（CPAP）依从性的信息。
除了 AHI 之外，与 OSA 相关的因素被证明是复合 CV 结局的重要预测因素，应在未来的研究和临床实践中加以考虑。
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