睡眠呼吸暂停及持续气道正压通气治疗在女性中卒中和冠心病发病中的作用。

Role of sleep apnea and continuous positive airway pressure therapy in the incidence of stroke or coronary heart disease in women.

机构信息

1 Respiratory Department and.

出版信息

Am J Respir Crit Care Med. 2014 Jun 15;189(12):1544-50. doi: 10.1164/rccm.201311-2012OC.

DOI:10.1164/rccm.201311-2012OC

PMID:24673616

Abstract

RATIONALE

It is unknown whether obstructive sleep apnea (OSA) may be a risk factor for incident cardiovascular events in women.

OBJECTIVES

We sought to investigate whether OSA increases the incidence of a composite of stroke or coronary heart disease (CHD) in women, and the role of continuous positive airway pressure (CPAP) treatment on this association.

METHODS

This was a prospective, observational study conducted in two Spanish teaching hospitals between 1998 and 2007. Consecutive women referred for suspected OSA and free of previous stroke and CHD were analyzed. Women with an apnea-hypopnea index (AHI) less than 10 comprised the control group, and those with an AHI greater than or equal to 10 were diagnosed with OSA and classified as CPAP-treated (adherence ≥ 4 h/d) or untreated (adherence < 4 h/d or not prescribed). The follow-up ended in December 2010.

MEASUREMENTS AND MAIN RESULTS

A total of 967 women were studied (median follow-up, 6.8 yr; interquartile range, 5.2-8.2). The untreated OSA group showed a greater incidence rate of the composite outcome than the control group (2.19 vs. 0.54 per 100 person-years; P < 0.0005). Compared with the control group, the fully adjusted hazard ratios for the composite outcome incidence were 2.76 (95% confidence interval [CI], 1.35-5.62) for the untreated OSA group, and 0.91 (95% CI, 0.43-1.95) for the CPAP-treated group. When the type of cardiovascular event was separately assessed, untreated OSA showed a stronger association with incident stroke (adjusted hazard ratio, 6.44; 95% CI, 1.46-28.3) than with CHD (adjusted hazard ratio, 1.77; 95% CI, 0.76-4.09).

CONCLUSIONS

In women, untreated OSA is associated with increased incidence of serious cardiovascular outcomes, particularly incident stroke. Adequate CPAP treatment seems to reduce this risk.

摘要

背景

阻塞性睡眠呼吸暂停（OSA）是否可能是女性发生心血管事件的一个危险因素尚不清楚。

目的

我们旨在研究 OSA 是否会增加女性中风或冠心病（CHD）复合事件的发生率，以及持续气道正压通气（CPAP）治疗对此相关性的作用。

方法

这是一项于 1998 年至 2007 年在两家西班牙教学医院进行的前瞻性、观察性研究。对因疑似 OSA 而就诊且无既往中风和 CHD 的连续女性进行了分析。呼吸暂停低通气指数（AHI）<10 的女性组成对照组，AHI≥10 的女性被诊断为 OSA，并分为 CPAP 治疗（依从性≥4 h/d）或未治疗（依从性<4 h/d 或未开处方）组。随访于 2010 年 12 月结束。

测量和主要结果

共研究了 967 名女性（中位随访时间 6.8 年；四分位距 5.2-8.2）。未治疗的 OSA 组的复合结局发生率高于对照组（2.19 与 0.54/100 人年；P<0.0005）。与对照组相比，复合结局发生率的校正后危险比分别为未治疗的 OSA 组 2.76（95%置信区间[CI]，1.35-5.62）和 CPAP 治疗组 0.91（95%CI，0.43-1.95）。当分别评估心血管事件类型时，未治疗的 OSA 与中风发生率之间的相关性更强（校正后危险比，6.44；95%CI，1.46-28.3），与 CHD 发生率之间的相关性较弱（校正后危险比，1.77；95%CI，0.76-4.09）。