Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Int J Cardiol. 2018 Apr 15;257:125-130. doi: 10.1016/j.ijcard.2017.10.089.
Obstructive sleep apnea (OSA) and resistant hypertension (RHTN) are two major risk factors of chronic heart failure (CHF) and limited information is available about the joint effects of OSA and RHTN on CHF.
Baseline data of participants who had completed polysomnography were used in the current study. The relative excess risk due to interaction (RERI) and attributable proportion due to interaction (AP) were calculated, and RERI >0 or AP >0 indicates joint effect of OSA and RHTN on CHF is greater than the sum of estimated effects of OSA alone and RHTN alone. Due to significant interaction between coronary heart disease (CHD) and both OSA and RHTN, participants were stratified into with and without CHD subgroups.
Among 1157 participants, 33.1% had OSA. The prevalence of RHTN in OSA participants was 18.3%. The apnea-hypopnea index (AHI), pulse pressure and CHF were significantly associated with RHTN. In the CHD subgroup, participants with OSA and RHTN were associated with >3-fold increased odds of prevalent CHF. RERI was 2.66 and AP was 0.75. The odds of prevalent CHF with left ventricular ejection fraction (LVEF) ≥45% in participants with OSA+RHTN were >2-fold higher compared to those without, or with either OSA or RHTN, and RERI was 1.50 and AP was 0.72.
Presence of CHF, increased AHI and pulse pressure are independently associated with RHTN. OSA and RHTN have significant joint effects on CHF, especially in patients with concurrent CHD and preserved LVEF.
阻塞性睡眠呼吸暂停（OSA）和难治性高血压（RHTN）是慢性心力衰竭（CHF）的两个主要危险因素，关于 OSA 和 RHTN 对 CHF 的联合影响的信息有限。
本研究使用了完成多导睡眠图检查的参与者的基线数据。计算了交互作用的相对超额危险度（RERI）和归因比例（AP），当 RERI>0 或 AP>0 时，表示 OSA 和 RHTN 对 CHF 的联合作用大于 OSA 单独和 RHTN 单独的估计作用之和。由于冠心病（CHD）与 OSA 和 RHTN 之间存在显著的交互作用，因此将参与者分为有和无 CHD 亚组。
在 1157 名参与者中，33.1%有 OSA。OSA 患者中 RHTN 的患病率为 18.3%。呼吸暂停-低通气指数（AHI）、脉压和 CHF 与 RHTN 显著相关。在 CHD 亚组中，患有 OSA 和 RHTN 的参与者患 CHF 的几率增加了 3 倍以上。RERI 为 2.66，AP 为 0.75。与无 OSA 或 RHTN 的患者相比，OSA+RHTN 患者左心室射血分数（LVEF）≥45%时，CHF 的患病率增加了>2 倍，RERI 为 1.50，AP 为 0.72。
CHF 的存在、AHI 和脉压的增加与 RHTN 独立相关。OSA 和 RHTN 对 CHF 有显著的联合作用，特别是在合并 CHD 和保留 LVEF 的患者中。
