Jennum Poul, Tønnesen Philip, Ibsen Rikke, Kjellberg Jakob
Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Sleep Med. 2017 Aug;36:62-66. doi: 10.1016/j.sleep.2017.04.018. Epub 2017 May 27.
Most studies have used cardiovascular and cerebrovascular disease (CVD) end-points to measure the effect of continuous positive airway pressure (CPAP), but pre-diagnostic morbidities involve a range of comorbidities that may influence the consequences of obstructive sleep apnea (OSA). We therefore aimed to evaluate all-cause total mortality after a diagnosis of OSA, the effect of CPAP in women and men, and the potential effect of major comorbidities.
We used national registry data as a historical cohort and included 22,135 OSA patients aged 20 years or more with comorbidity data three years before diagnosis and follow-up morbidity and mortality over a period of 17 years.
A total of 8129 (37%) accepted CPAP for more than six months; 14,006 (63%) were CPAP non-user/non-compliant. Those treated with CPAP tended to have higher mortality rates. Patients treated with CPAP were more likely to be male, elderly, suffer from diabetes, and present with more cardiovascular diseases than those not treated with CPAP. After a diagnosis of OSA, more patients in the CPAP-treated group developed cardiovascular complications. Female gender was associated with lower mortality, whereas age, diabetes type 2, and hypertension prior to OSA diagnosis were associated with negative effects on outcome. After an OSA diagnosis, male gender, age, diabetes (types 1 and 2), hypertension, and heart failure were all associated with greater mortality. CPAP treatment had a positive effect in middle-aged and elderly people, whereas CPAP in females had no effect on all-cause mortality.
CPAP-treated patients present more comorbidities before and after diagnosis compared with non-treated/non-compliant patients, which explains the higher mortality in this group. CPAP treatment is associated with lower mortality rates in middle-aged and elderly (aged 60+ years) males, but only after adjustment for multiple comorbidities. No effect of CPAP treatment on all-cause mortality in female OSA patients was found. Males with OSA, older than 40 years, with comorbidities and a low educational level presented a particularly high mortality risk.
大多数研究使用心血管和脑血管疾病（CVD）终点来衡量持续气道正压通气（CPAP）的效果，但诊断前的发病情况涉及一系列可能影响阻塞性睡眠呼吸暂停（OSA）后果的合并症。因此，我们旨在评估OSA诊断后的全因总死亡率、CPAP对男性和女性的影响以及主要合并症的潜在影响。
我们将国家登记数据用作历史队列，纳入了22135例年龄在20岁及以上的OSA患者，这些患者在诊断前三年有合并症数据，并在17年期间有后续发病和死亡情况。
共有8129例（37%）接受CPAP治疗超过6个月；14006例（63%）未使用/未依从CPAP治疗。接受CPAP治疗的患者死亡率往往较高。与未接受CPAP治疗的患者相比，接受CPAP治疗的患者更可能为男性、年龄较大、患有糖尿病且患有更多心血管疾病。在诊断为OSA后，CPAP治疗组中有更多患者出现心血管并发症。女性性别与较低死亡率相关，而年龄、2型糖尿病和OSA诊断前的高血压对预后有负面影响。在诊断为OSA后，男性性别、年龄、糖尿病（1型和2型）、高血压和心力衰竭均与较高死亡率相关。CPAP治疗对中年和老年人有积极作用，而CPAP对女性的全因死亡率没有影响。
与未治疗/未依从治疗的患者相比，接受CPAP治疗的患者在诊断前后合并症更多，这解释了该组死亡率较高的原因。CPAP治疗与中年和老年（60岁及以上）男性较低的死亡率相关，但仅在调整多种合并症后。未发现CPAP治疗对女性OSA患者的全因死亡率有影响。年龄超过40岁、有合并症且教育水平较低的男性OSA患者死亡风险特别高。
