Yaranov Dmitry M, Smyrlis Athanasios, Usatii Natalia, Butler Amber, Petrini Joann R, Mendez Jose, Warshofsky Mark K
Department of Medicine, Danbury Hospital, Western Connecticut Health Network, Danbury, Connecticut.
Department of Cardiology, Danbury Hospital, Western Connecticut Health Network, Danbury, Connecticut.
Am J Cardiol. 2015 Feb 15;115(4):461-5. doi: 10.1016/j.amjcard.2014.11.027. Epub 2014 Nov 29.
Obstructive sleep apnea (OSA) is an independent risk factor for ischemic stroke that is not included in the usual cardioembolic risk assessments for patients with atrial fibrillation (AF). The aim of this study was to investigate the impact of OSA on stroke rate in patients with AF. Patients with AF and new diagnoses of OSA were identified from retrospective chart review. Those with histories of stroke at the time of the sleep study were excluded. The primary outcome was the incidence of stroke, determined by a physician investigator blinded to the results of polysomnography. Subgroup analysis was performed among different CHADS₂ and CHA₂DS₂-VASc scores. Of 5,138 patients screened for OSA, 402 (7.7%) had AF and 332 (6.4%) met the inclusion criteria. Among the study population, the occurrence of first-time stroke was 22.9%. Ischemic stroke was more common in patients with OSA compared with patients without (25.4% vs 8.2% respectively, p = 0.006). After controlling for age, male gender, and coronary artery disease, the association between OSA and stroke remained statistically significant, with an adjusted odds ratio of 3.65 (95% confidence interval 1.252 to 10.623). A positive dose effect of the apnea-hypopnea index on the rate of stroke was observed (p = 0.0045). Subgroup analysis showed significantly higher rates of stroke in patients with CHADS₂ scores of 0 and CHA₂DS₂-VASc scores of 0 and 1 and co-morbid OSA. In conclusion, OSA in patients with AF is an independent predictor of stroke. This association may have important clinical implications in ischemic stroke risk stratification.
阻塞性睡眠呼吸暂停（OSA）是缺血性中风的独立危险因素，而心房颤动（AF）患者的常规心脏栓塞风险评估中并未包含这一因素。本研究的目的是调查OSA对AF患者中风发生率的影响。通过回顾性病历审查确定患有AF且新诊断为OSA的患者。睡眠研究时患有中风病史的患者被排除。主要结局是中风发生率，由对多导睡眠图结果不知情的医师研究者确定。在不同的CHADS₂和CHA₂DS₂-VASc评分中进行亚组分析。在筛查OSA的5138例患者中，402例（7.7%）患有AF，332例（6.4%）符合纳入标准。在研究人群中，首次中风的发生率为22.9%。与无OSA的患者相比，OSA患者发生缺血性中风更为常见（分别为25.4%和8.2%，p = 0.006）。在控制年龄、男性性别和冠状动脉疾病后，OSA与中风之间的关联仍具有统计学意义，调整后的优势比为3.65（95%置信区间为1.252至10.623）。观察到呼吸暂停低通气指数对中风发生率有正向剂量效应（p = 0.0045）。亚组分析显示，CHADS₂评分为0、CHA₂DS₂-VASc评分为0和1且合并OSA的患者中风发生率显著更高。总之，AF患者中的OSA是中风的独立预测因素。这种关联可能在缺血性中风风险分层中具有重要的临床意义。
