Wong Jim K, Mariano Edward R, Doufas Anthony G, Olejniczak Megan J, Kushida Clete A
Department of Anesthesiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
Department of Anesthesiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Department of Anesthesiology, Pain, and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA.
J Cardiothorac Vasc Anesth. 2017 Aug;31(4):1250-1256. doi: 10.1053/j.jvca.2016.11.016. Epub 2016 Nov 14.
Based on clinical studies in the nonsurgical population that positive airway pressure (PAP) therapy for patients with obstructive sleep apnea (OSA) provides benefits for those with atrial fibrillation, the authors tested the hypothesis that PAP in patients with OSA reduces the incidence of postoperative atrial fibrillation (POAF) after cardiac surgery.
Retrospective analysis.
Single-center university hospital.
The study comprised 192 patients in sinus rhythm preoperatively who were undergoing nontransplantation or ventricular assist device implantation cardiac surgery requiring cardiopulmonary bypass but not requiring systemic circulatory arrest, with documented PAP adherence from January 2008 to October 2015.
Retrospective review of medical records.
POAF was defined as atrial fibrillation requiring therapeutic intervention. Of the 192 patients with OSA, 104 (54%) were documented to be PAP-adherent and 88 (46%) were reported to be PAP-nonadherent. Among PAP users, 49 (47%) developed POAF; among PAP nonusers, 59 (66%) developed POAF. The adjusted hazard ratio was 0.59 (95% confidence interval 0.40-0.86, p<0.01). No differences were observed in intensive care unit length of stay (4.0±3.4 days for PAP-adherent group v 5.0±6.2 days for PAP-nonadherent group; p = 0.22) or hospital length of stay (10.7±6.6 days for PAP-adherent group v 10.9±7.3 days for PAP nonadherent group; p = 0.56). A lower median postoperative creatinine rise was observed in PAP-adherent patients (18.2% [8.3%-37.5%) v 31.3% [13.3%-50%]; p< 0.01).
Preoperative PAP use in patients with OSA was associated with a decreased rate of POAF after cardiac surgery.
基于非手术人群的临床研究，即阻塞性睡眠呼吸暂停（OSA）患者的气道正压（PAP）治疗对心房颤动患者有益，作者检验了以下假设：OSA患者使用PAP可降低心脏手术后发生术后心房颤动（POAF）的发生率。
回顾性分析。
单中心大学医院。
该研究纳入了192例术前处于窦性心律的患者，这些患者正在接受非移植或心室辅助装置植入的心脏手术，需要体外循环但不需要全身循环停止，且在2008年1月至2015年10月期间有PAP依从性记录。
回顾医疗记录。
POAF定义为需要治疗干预的心房颤动。在192例OSA患者中，有104例（54%）记录为PAP依从，88例（46%）报告为PAP不依从。在使用PAP的患者中，49例（47%）发生了POAF；在未使用PAP的患者中，59例（66%）发生了POAF。调整后的风险比为0.59（95%置信区间0.40 - 0.86，p<0.01）。在重症监护病房住院时间方面未观察到差异（PAP依从组为4.0±3.4天，PAP不依从组为5.0±6.2天；p = 0.22）或住院时间方面也未观察到差异（PAP依从组为10.7±6.6天，PAP不依从组为10.9±7.3天；p = 0.56）。PAP依从患者术后肌酐升高的中位数较低（18.2% [8.3% - 37.5%] 对比31.3% [13.3% - 50%]；p<0.01）。
OSA患者术前使用PAP与心脏手术后POAF发生率降低相关。
