阻塞性睡眠呼吸暂停及持续气道正压通气治疗对心房颤动患者预后的影响——心房颤动更优知情治疗结果登记研究（ORBIT-AF）的结果
Impact of obstructive sleep apnea and continuous positive airway pressure therapy on outcomes in patients with atrial fibrillation-Results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF).
作者信息
Holmqvist Fredrik, Guan Ni, Zhu Zhaoyin, Kowey Peter R, Allen Larry A, Fonarow Gregg C, Hylek Elaine M, Mahaffey Kenneth W, Freeman James V, Chang Paul, Holmes DaJuanicia N, Peterson Eric D, Piccini Jonathan P, Gersh Bernard J
机构信息
Duke Clinical Research Institute, Durham, NC.
Duke Clinical Research Institute, Durham, NC.
出版信息
Am Heart J. 2015 May;169(5):647-654.e2. doi: 10.1016/j.ahj.2014.12.024. Epub 2015 Feb 7.
BACKGROUND
Obstructive sleep apnea (OSA) is common in patients with atrial fibrillation (AF). Little is known about the impact of OSA on AF treatment and long-term outcomes. We studied whether patients with OSA have a greater likelihood of progressing to more persistent forms of AF or require more hospitalizations and/or worse outcomes compared with patients without OSA.
METHODS
A total of 10,132 patients were enrolled between June 2010 and August 2011 in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) and followed for up to 2 years. The prevalence of OSA and continuous positive airway pressure (CPAP) treatment was captured at baseline. The association between OSA and major cardiovascular outcomes was analyzed using multivariable hierarchical logistic regression modeling and Cox frailty regression model.
RESULTS
Of the 10,132 patients with AF, 1,841 had OSA. Patients with OSA were more symptomatic (22% vs 16% severe/disabling symptoms; P < .0001) and more often on rhythm control therapy (35% vs 31%; P = .0037). In adjusted analyses, patients with OSA had higher risk of hospitalization (hazard ratio [HR], 1.12; 95% CI, 1.03-1.22; P = .0078), but no difference in the risks of death (HR, 0.94; 95% CI, 0.77-1.15; P = .54); the composite of CV death, myocardial infarction, and stroke/transient ischemic attack (HR, 1.07; 95% CI, 0.85-1.34; P = .57); major bleeding (HR, 1.18; 95% CI, 0.96-1.46; P = .11); or AF progression (HR, 1.06; 95% CI, 0.89-1.28; P = .51). Patients with OSA on CPAP treatment were less likely to progress to more permanent forms of AF compared with patients without CPAP (HR, 0.66; 95% CI, 0.46-0.94; P = .021).
CONCLUSION
Compared with those without, AF patients with OSA have worse symptoms and higher risks of hospitalization, but similar mortality, major adverse cardiovascular outcome, and AF progression rates.
CLINICAL TRIAL REGISTRATION
NCT01165710 (http://www.clinicaltrials.gov).
背景
阻塞性睡眠呼吸暂停（OSA）在心房颤动（AF）患者中很常见。关于OSA对AF治疗及长期预后的影响，人们了解甚少。我们研究了与无OSA的患者相比，OSA患者进展为更持续性AF形式的可能性是否更高，或者是否需要更多住院治疗和/或预后更差。
方法
2010年6月至2011年8月期间，共有10132例患者纳入房颤更明智治疗结果登记研究（ORBIT-AF），并随访长达2年。在基线时记录OSA和持续气道正压通气（CPAP）治疗的患病率。使用多变量分层逻辑回归模型和Cox脆弱回归模型分析OSA与主要心血管结局之间的关联。
结果
在10132例AF患者中，1841例患有OSA。OSA患者症状更明显（严重/致残症状分别为22% vs 16%；P <.0001），且更常接受节律控制治疗（35% vs 31%；P =.0037）。在调整分析中，OSA患者住院风险更高（风险比[HR]，1.12；95%CI，1.03 - 1.22；P =.0078），但死亡风险无差异（HR，0.94；95%CI，0.77 - 1.15；P =.54）；心血管死亡、心肌梗死和中风/短暂性脑缺血发作的复合终点（HR，1.07；95%CI，0.85 - 1.34；P =.57）；大出血（HR，1.18；95%CI，0.96 - 1.46；P =.11）；或AF进展（HR，1.06；95%CI，0.89 - 1.28；P =.51）。与未接受CPAP治疗的患者相比，接受CPAP治疗的OSA患者进展为更永久性AF形式的可能性更小（HR，0.66；95%CI，0.46 - 0.94；P =.021）。
结论
与无OSA的AF患者相比，有OSA的AF患者症状更差，住院风险更高，但死亡率、主要不良心血管结局和AF进展率相似。
临床试验注册
NCT01165710（http://www.clinicaltrials.gov）
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