Gupta Madhulika A, Knapp Katie
Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
PLoS One. 2014 Mar 5;9(3):e90021. doi: 10.1371/journal.pone.0090021. eCollection 2014.
To evaluate cardiovascular and psychiatric morbidity in patient visits with obstructive sleep apnea (OSA) with insomnia (OSA+Insomnia) versus OSA without insomnia (OSA-Insomnia) in a nationally representative US sample.
A retrospective case-control study of epidemiologic databases (National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey) representing an estimated ± standard error (SE) 62,253,910 ± 5,274,747 (unweighted count=7234) patient visits with diagnosis of OSA from 1995-2010, was conducted. An estimated 3,994,104 ± 791,386 (unweighted count=658) were classified as OSA+Insomnia and an estimated 58,259,806 ± 4,849,800 (unweighted count=6576) as OSA-Insomnia. Logistic regression analysis was carried out using OSA+Insomnia versus OSA-Insomnia as the dependent variable, and age (>50 years versus ≤ 50 years), sex, race ('White' versus 'non-White'), essential hypertension, heart failure, ischemic heart disease, cardiac dysrhythmia, cerebrovascular disease, diabetes, obesity, hyperlipidemia, depressive, anxiety, and adjustment disorders (includes PTSD), hypersomnia and all medications used as independent variables. All comorbidities were physician diagnosed using the ICD9-CM.
Among patient visits with OSA, an estimated 6.4%± 0.9% also had insomnia. Logistic regression analysis revealed that the OSA+Insomnia group was significantly more likely to have essential hypertension (all ICD9-CM codes 401) (OR=1.83, 95% CI 1.27-2.65) and provisionally more likely to have cerebrovascular disease (ICD9-CM codes 430-438) (OR=6.58, 95% CI 1.66-26.08). The significant OR for cerebrovascular disease was considered provisional because the unweighted count was <30.
In a nationally representative sample, OSA+Insomnia was associated significantly more frequently with essential hypertension than OSA-Insomnia, a finding that has not been previously reported. In contrast to studies that have considered patient self-reports of psychological morbidity, the absence of a significant association with psychiatric disorders in our study may be indicative of the fact that we considered only physician-rated psychiatric syndromes meeting ICD9-CM criteria. Our findings among the OSA+Insomnia group are therefore most likely conservative.
在美国具有全国代表性的样本中，评估患有阻塞性睡眠呼吸暂停（OSA）合并失眠（OSA + 失眠）的患者与未合并失眠的OSA患者（OSA - 失眠）的心血管和精神疾病发病率。
对流行病学数据库（国家门诊医疗护理调查和国家医院门诊医疗护理调查）进行回顾性病例对照研究，这些数据库代表了1995 - 2010年期间估计±标准误差（SE）为62,253,910 ± 5,274,747（未加权计数 = 7234）例诊断为OSA的患者就诊情况。估计3,994,104 ± 791,386（未加权计数 = 658）例被分类为OSA + 失眠，估计58,259,806 ± 4,849,800（未加权计数 = 6576）例为OSA - 失眠。以OSA + 失眠与OSA - 失眠作为因变量，年龄（>50岁与≤50岁）、性别、种族（“白人”与“非白人”）、原发性高血压、心力衰竭、缺血性心脏病、心律失常、脑血管疾病、糖尿病、肥胖、高脂血症、抑郁、焦虑和适应障碍（包括创伤后应激障碍）、嗜睡以及所有使用的药物作为自变量进行逻辑回归分析。所有合并症均根据国际疾病分类第九版临床修订本（ICD9 - CM）由医生诊断。
在患有OSA的患者就诊中，估计6.4%±0.9%的患者也患有失眠。逻辑回归分析显示，OSA + 失眠组患原发性高血压（所有ICD9 - CM编码401）的可能性显著更高（OR = 1.83，95%置信区间1.27 - 2.65），并且患脑血管疾病（ICD9 - CM编码430 - 438）的可能性暂时更高（OR = 6.58，95%置信区间1.66 - 26.08）。脑血管疾病的显著OR被认为是暂时的，因为未加权计数<30。
在具有全国代表性的样本中，OSA + 失眠比OSA - 失眠更频繁地与原发性高血压显著相关，这一发现此前尚未见报道。与考虑患者心理疾病自我报告的研究不同，我们的研究中与精神障碍无显著关联可能表明我们仅考虑了符合ICD9 - CM标准的医生评定的精神综合征。因此，我们在OSA + 失眠组中的发现很可能是保守的。
