阻塞性睡眠呼吸暂停（OSA）严重程度是大型睡眠诊所队列中发生心房颤动住院的独立预测因子。
Severity of OSA is an independent predictor of incident atrial fibrillation hospitalization in a large sleep-clinic cohort.
机构信息
Centre for Genetic Origins of Health and Disease, Sir Charles Gairdner Hospital Unit, University of Western Australia, Crawley.
School of Anatomy, Physiology and Human Biology, Sir Charles Gairdner Hospital Unit, University of Western Australia, Crawley; West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
出版信息
Chest. 2015 Oct;148(4):945-952. doi: 10.1378/chest.15-0229.
BACKGROUND
OSA is a common condition that has been associated with atrial fibrillation (AF), but there is a paucity of data from large longitudinal cohorts to establish whether OSA is a risk factor for AF independent of obesity and other established risk factors.
METHODS
We studied patients attending a sleep clinic referred for in-laboratory polysomnography for possible OSA between 1989 and 2001. Whole-population hospital data in Western Australia for 1970 to 2009 were linked to sleep study cases to determine incident AF hospitalization to 2009. Cox regression analyses were used to assess the independent association of OSA with incident AF.
RESULTS
Study case subjects (6,841) were predominantly middle aged (48.3 ± 12.5 years old) and men (77%), and 455 developed AF during a median 11.9 years of follow-up. Univariate predictors of AF included age, BMI, hypertension, diabetes, valvular heart disease, coronary or peripheral artery disease, heart failure, and COPD (all P < .001). After multivariable adjustment, independent predictors of incident AF were an apnea/hypopnea index (AHI) > 5/h (hazard ratio [HR], 1.55; 95% CI, 1.21-2.00), log (AHI + 1) (HR, 1.15; 95% CI, 1.06-1.26), and log (time with oxygen saturation < 90% + 1) (HR, 1.12; 95% CI, 1.06-1.19). There were no interactions between age, sex, or BMI and AHI for AF development.
CONCLUSIONS
OSA diagnosis and severity are independently associated with incident AF. Clinical trials are required to determine if treatment of OSA will reduce the burden of AF.
背景
阻塞性睡眠呼吸暂停（OSA）是一种常见病症，与心房颤动（AF）有关，但缺乏大规模纵向队列研究的数据来确定 OSA 是否是独立于肥胖和其他已确立的危险因素的 AF 风险因素。
方法
我们研究了 1989 年至 2001 年间在睡眠诊所就诊并接受实验室多导睡眠图检查以确定可能的 OSA 的患者。将 1970 年至 2009 年西澳大利亚州的全人群医院数据与睡眠研究病例相关联，以确定 2009 年之前的 AF 住院事件。使用 Cox 回归分析评估 OSA 与 AF 事件的独立关联。
结果
研究病例患者（6841 例）主要为中年（48.3±12.5 岁）和男性（77%），在中位 11.9 年的随访期间有 455 例发生 AF。AF 的单变量预测因素包括年龄、BMI、高血压、糖尿病、瓣膜性心脏病、冠状动脉或外周动脉疾病、心力衰竭和 COPD（均<0.001）。多变量调整后，AF 事件的独立预测因素包括每小时呼吸暂停/低通气指数（AHI）>5（风险比[HR]，1.55；95%可信区间，1.21-2.00）、log（AHI+1）（HR，1.15；95%可信区间，1.06-1.26）和 log（血氧饱和度<90%+1 的时间）（HR，1.12；95%可信区间，1.06-1.19）。年龄、性别或 BMI 与 AHI 之间不存在 AF 发展的相互作用。
结论
OSA 的诊断和严重程度与 AF 的发生独立相关。需要进行临床试验以确定治疗 OSA 是否会降低 AF 的负担。
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