Schipper Mirjam H, Jellema Korne, Thomassen Bregje J W, Alvarez-Estevez Diego, Verbraecken Johan, Rijsman Roselyne M
Department of Neurology, Haaglanden Medical Center, PO Box 432, 2501 CK, The Hague, The Netherlands.
Center for Sleep and Wake Disorders, Haaglanden Medical Center, The Hague, The Netherlands.
J Neurol. 2017 Jun;264(6):1247-1253. doi: 10.1007/s00415-017-8522-z. Epub 2017 May 26.
Obstructive sleep apnea (OSA) is a known-risk factor for cardiovascular diseases. There are indications that treatment with continuous positive airway pressure (CPAP) reduces the risk of new cardiovascular events. In this study, we analyzed the incidence of cardiovascular events in patients with OSA and compared for the impact of CPAP therapy. All polysomnographies performed in 2009 and 2010 were selected with an AHI ≥5 and patients older than 18 years. These 1110 patients were approached with a questionnaire about cardiovascular events and CPAP treatment. Finally, 554 patients were included in analyses. CPAP treatment was based on compliance (level 1 treatment) and extended with residual respiratory events (level 2 treatment). OSA was set as AHI ≥5 and classified in mild (AHI 5-15), moderate (AHI 15-30) and severe (AHI ≥30) OSA. 50 cardiovascular events occurred in 44 patients during follow-up (mean follow-up time 5.9 years) in 554 patients. The events were significantly higher in patients with increasing classification of OSA-severity (p = 0.016). A first-ever cardiovascular event did not differ significantly between mild, moderate and severe OSA. Untreated CPAP patients had significantly more cardiovascular events as compared to treated patients with a hazard ratio of 2.66 partially adjusted for age, AHI and smoking. There was no significant contribution of other cardiovascular risk factors. Patients with OSA with an indication for CPAP treatment have more cardiovascular events when untreated compared to treated patients. This indicates that treatment of OSA by CPAP can reduce the risk for cardiovascular events.
阻塞性睡眠呼吸暂停（OSA）是心血管疾病的已知危险因素。有迹象表明，持续气道正压通气（CPAP）治疗可降低新发心血管事件的风险。在本研究中，我们分析了OSA患者心血管事件的发生率，并比较了CPAP治疗的影响。选取2009年和2010年进行的所有多导睡眠图检查，其中呼吸暂停低通气指数（AHI）≥5且年龄大于18岁的患者。对这1110名患者进行了关于心血管事件和CPAP治疗的问卷调查。最后，554名患者纳入分析。CPAP治疗基于依从性（1级治疗），并根据残余呼吸事件进行扩展（2级治疗）。OSA定义为AHI≥5，并分为轻度（AHI 5 - 15）、中度（AHI 15 - 30）和重度（AHI≥30）OSA。在554名患者的随访期间（平均随访时间5.9年），44名患者发生了50次心血管事件。随着OSA严重程度分级增加，事件发生率显著升高（p = 0.016）。轻度、中度和重度OSA患者首次发生心血管事件的差异无统计学意义。与接受治疗的患者相比，未接受CPAP治疗的患者心血管事件显著更多，风险比为2.66，部分调整了年龄、AHI和吸烟因素。其他心血管危险因素无显著影响。有CPAP治疗指征的OSA患者未治疗时比治疗患者发生更多心血管事件。这表明CPAP治疗OSA可降低心血管事件风险。
