2Neurosurgery, LSU Health-Shreveport, Louisiana.
Departments of1Neurology and Sleep Medicine and.
J Neurosurg. 2018 Mar;128(3):735-746. doi: 10.3171/2016.10.JNS162316. Epub 2017 Mar 21.
OBJECTIVE Obstructive sleep apnea (OSA) is associated with the progression of abdominal and thoracic aortic aneurysms. However, the role of OSA in the overall outcome of intracranial aneurysms (IAs) has not yet been established. Authors of this report investigated the role of OSA in the overall outcome of IAs. METHODS Radiological and clinical data on patients (from 2010 through 2015) with confirmed IA were retrospectively reviewed. Significant differences between the OSA and non-OSA groups were determined using a chi-square test. Logistic regression analysis was performed to identify the predictors of an unfavorable IA outcome. RESULTS Among the 283 patients with confirmed IAs, 45 patients (16%) were positively screened for OSA, a proportion that was significantly higher than the prevalence of OSA in nonaneurysmal neurosurgical patients (4%, p = 0.008). The percentage of patients with hypertension (p = 0.018), a body mass index ≥ 30 kg/m (p < 0.0001), hyperlipidemia (p = 0.034), diabetes mellitus (p = 0.005), chronic heart disease (CHD; p = 0.024), or prior stroke (p = 0.03) was significantly higher in the OSA group than in the non-OSA group. Similarly, the percentage of wide-necked aneurysms (p = 0.00001) and patients with a poor Hunt and Hess Grade IV-V (p = 0.01) was significantly higher in the OSA group than in the non-OSA group. In addition, the percentage of ruptured aneurysms (p = 0.03) and vasospasms (p = 0.03) was significantly higher in the OSA group. The percentage of patients with poor modified Rankin Scale (mRS) scores (3-6) was significantly higher in the OSA group (p = 0.03). A separate cohort of patients with ruptured IAs showed similar results. In both univariate (p = 0.01) and multivariate (p = 0.04) regression analyses, OSA was identified as an individual predictor of an unfavorable outcome. In addition, hypertension and prior stroke were revealed as predictors of a poor IA outcome. CONCLUSIONS Complications of IA such as rupture and vasospasm are often the consequence of uncontrolled OSA. Overall outcome (mRS) of IAs is also affected by the co-occurrence of OSA. Therefore, the coexistence of OSA with IA affects the outcome of IAs. Obstructive sleep apnea is a risk factor for a poor outcome in IA patients.
目的 阻塞性睡眠呼吸暂停（OSA）与腹主动脉瘤和胸主动脉瘤的进展有关。然而，OSA 对颅内动脉瘤（IA）整体预后的作用尚未确定。本报告的作者研究了 OSA 在 IA 整体预后中的作用。
方法 回顾性分析 2010 年至 2015 年间经证实的 IA 患者的影像学和临床数据。使用卡方检验确定 OSA 组和非 OSA 组之间的显著差异。采用 logistic 回归分析确定 IA 不良结局的预测因素。
结果 在 283 例确诊的 IA 患者中，45 例（16%）被阳性筛查出 OSA，这一比例明显高于非动脉瘤神经外科患者中 OSA 的患病率（4%，p=0.008）。OSA 组高血压（p=0.018）、体质指数≥30kg/m（p<0.0001）、高血脂（p=0.034）、糖尿病（p=0.005）、慢性心脏病（CHD；p=0.024）或既往卒中（p=0.03）的患者比例明显高于非 OSA 组。同样，OSA 组宽颈动脉瘤（p=0.00001）和 Hunt 和 Hess 分级 IV-V 级差的患者比例（p=0.01）明显高于非 OSA 组。此外，OSA 组破裂动脉瘤（p=0.03）和血管痉挛（p=0.03）的患者比例明显较高。OSA 组改良 Rankin 量表（mRS）评分较差（3-6 分）的患者比例明显较高（p=0.03）。另一组破裂的 IA 患者也显示出类似的结果。在单变量（p=0.01）和多变量（p=0.04）回归分析中，OSA 被确定为不良预后的个体预测因子。此外，高血压和既往卒中被确定为 IA 不良预后的预测因子。
结论 IA 并发症，如破裂和血管痉挛，通常是未得到控制的 OSA 的后果。IA 的整体预后（mRS）也受到 OSA 合并症的影响。因此，OSA 与 IA 的共存会影响 IA 的预后。阻塞性睡眠呼吸暂停是 IA 患者预后不良的危险因素。
