Martins Emerson Ferreira, Martinez Denis, da Silva Fernando A Boeira Sabino, Sezerá Lauren, da Rosa de Camargo Rodrigo, Fiori Cintia Zappe, Fuchs Flávio Danni, Moraes Ruy Silveira
Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Cardiology Division, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Graduate Program in Medical Sciences, (UFRGS), Brazil; Cardiology Division, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Department of Medicine, School of Medicine, UFRGS, Porto Alegre, RS, Brazil.
Sleep Med. 2017 Oct;38:144-150. doi: 10.1016/j.sleep.2017.06.027. Epub 2017 Jul 26.
Obstructive sleep apnea (OSA) patients who suffer sudden cardiac death die predominantly during the night. We aimed to investigate whether all cardiovascular-related deaths display the same night-time peak as sudden cardiac death.
Data from a large cohort of adults who underwent full-night polysomnography between 1985 and 2015 in a university-affiliated sleep clinic were analyzed. Time and cause of death of these patients and of persons from the general population were identified in death certificates from the State Health Secretariat. The day-night pattern of cardiovascular death was compared among groups of non-OSA, OSA (apnea-hypopnea index, AHI ≥5), CPAP users, and persons from the general population.
Among 619 certificates, 160 cardiovascular-related deaths were identified. The time of death of the 142 persons with OSA was uniformly distributed over 24 h, with neither an identifiable peak nor a circadian pattern (Rayleigh test; P = 0.8); the same flat distribution was seen in those with purported CPAP use (n = 49). Non-OSA individuals presented a morning peak and a night nadir of deaths, clearer when analyzed in eight-hour intervals. The same pattern was observed in 92 836 certificates from the State general population, with cardiovascular deaths showing the expected morning peak, night nadir, and a significant circadian pattern (Rayleigh test; P < 0.001).
In OSA patients, the distribution of cardiovascular-related deaths throughout the 24-h period is virtually flat, in contrast with the described nighttime peak of sudden cardiac death. OSA-related phenomena during nighttime might be blunting the mechanisms, arrhythmic or not, behind the morning peak of cardiovascular-related deaths.
阻塞性睡眠呼吸暂停（OSA）患者发生心源性猝死主要在夜间。我们旨在研究是否所有心血管相关死亡都与心源性猝死一样在夜间出现高峰。
分析了1985年至2015年间在一家大学附属睡眠诊所接受全夜多导睡眠图检查的一大群成年人的数据。这些患者以及普通人群的死亡时间和原因通过州卫生秘书处的死亡证明确定。比较了非OSA组、OSA组（呼吸暂停低通气指数，AHI≥5）、持续气道正压通气（CPAP）使用者组和普通人群的心血管死亡昼夜模式。
在619份死亡证明中，确定了160例心血管相关死亡。142例OSA患者的死亡时间在24小时内均匀分布，既没有明显的高峰也没有昼夜模式（瑞利检验；P = 0.8）；在据称使用CPAP的患者中（n = 49）也观察到相同的平坦分布。非OSA个体的死亡呈现出早晨高峰和夜间低谷，以八小时为间隔分析时更明显。在该州普通人群的92836份死亡证明中也观察到相同的模式，心血管死亡呈现出预期的早晨高峰、夜间低谷以及显著的昼夜模式（瑞利检验；P < 0.001）。
与所描述的心源性猝死夜间高峰不同，OSA患者心血管相关死亡在24小时内的分布实际上较为平坦。夜间与OSA相关的现象可能会削弱心血管相关死亡早晨高峰背后的机制，无论该机制是否与心律失常有关。
