睡眠呼吸暂停与肺炎风险：一项全国性基于人群的研究。
Sleep apnea and risk of pneumonia: a nationwide population-based study.
出版信息
CMAJ. 2014 Apr 1;186(6):415-21. doi: 10.1503/cmaj.131547. Epub 2014 Mar 3.
BACKGROUND
Evidence evaluating the risk of pneumonia in patients with obstructive sleep apnea is limited and mostly focuses on patients who receive continuous positive airway pressure (CPAP) therapy or on pediatric patients. We aimed to explore the risk of incident pneumonia among adults with sleep apnea, either with or without the need of CPAP therapy.
METHODS
From Jan. 1, 2000, we identified adult patients with sleep apnea from the Taiwan National Health Insurance Research Database. A control cohort without sleep apnea, matched for age, sex and comorbidities, was selected for comparison. The 2 cohorts were followed until Dec. 31, 2010, and observed for occurrence of pneumonia.
RESULTS
Of the 34,100 patients (6816 study patients and 27,284 matched controls), 2757 (8.09%) had pneumonia during a mean follow-up period of 4.50 years, including 638 (9.36%) study patients and 2119 (7.77%) controls. Kaplan-Meier analysis showed a higher incidence of pneumonia among patients with sleep apnea (log rank test, p < 0.001). After multivariate adjustment, patients with sleep apnea experienced a 1.20-fold (95% confidence interval 1.10-1.31) increase in incident pneumonia. The risk was even higher among patients who received CPAP therapy.
INTERPRETATION
Sleep apnea appeared to confer a higher risk for future pneumonia, possibly in a severity-dependent manner.
背景
评估阻塞性睡眠呼吸暂停患者肺炎风险的证据有限，且大多集中在接受持续气道正压通气（CPAP）治疗或儿科患者的研究上。我们旨在探讨无论是否需要 CPAP 治疗，成人睡眠呼吸暂停患者发生肺炎的风险。
方法
从 2000 年 1 月 1 日起，我们从台湾全民健康保险研究数据库中确定了患有睡眠呼吸暂停的成年患者。选择了一个年龄、性别和合并症相匹配的无睡眠呼吸暂停对照组进行比较。两组均随访至 2010 年 12 月 31 日，观察肺炎的发生情况。
结果
在 34100 名患者（6816 名研究患者和 27284 名匹配对照）中，2757 名（8.09%）患者在平均 4.50 年的随访期间发生肺炎，其中 638 名（9.36%）研究患者和 2119 名（7.77%）对照组。Kaplan-Meier 分析显示，睡眠呼吸暂停患者的肺炎发病率较高（对数秩检验，p<0.001）。经多变量调整后，睡眠呼吸暂停患者发生肺炎的风险增加 1.20 倍（95%置信区间 1.10-1.31）。接受 CPAP 治疗的患者风险更高。
结论
睡眠呼吸暂停似乎与未来肺炎的风险增加有关，这种风险可能与严重程度有关。
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