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脑血管疾病患者阻塞性睡眠呼吸暂停的患病率、危险因素、结局及治疗:一项系统评价

Prevalence, Risk Factors, Outcomes, and Treatment of Obstructive Sleep Apnea in Patients with Cerebrovascular Disease: A Systematic Review.

作者信息

Dong Ruifang, Dong Zhiling, Liu Hongmei, Shi Fangkun, Du Junfeng

机构信息

Department of Neurology, Hebei Cangzhou City Central Hospital, Cangzhou, China.

Department of Neurology, Hebei Cangzhou City Central Hospital, Cangzhou, China.

出版信息

J Stroke Cerebrovasc Dis. 2018 Jun;27(6):1471-1480. doi: 10.1016/j.jstrokecerebrovasdis.2017.12.048. Epub 2018 Mar 16.

Abstract

BACKGROUND

Obstructive sleep apnea (OSA) is known to increase the risk of cerebrovascular disease (CVD), and patients with CVD have high incidence of OSA. The study aimed to systematically evaluate the prevalence of OSA in patients with CVD.

MATERIALS AND METHODS

Medline, Embase, Science Citation Index, Wanfang, CNKI, and Wiley Online Library were thoroughly searched to identify relevant studies. Random-effects models were used to calculate the pooled rate estimates. Meta-regression and subgroup analysis were performed to explore potential sources of heterogeneity.

RESULTS

Thirty-seven studies with 3242 patients were analyzed. The prevalence of OSA (apnea hypopnea index [AHI] >10) ranged from 34.5% to 92.3%, the random-effects pooled prevalence was 61.9%. Furthermore, the prevalence of sleep disordered breathing (SDB) with AHI  greater than  5 was 70.4%, with AHI greater than 20 was 39.5%, and with AHI greater than 30 was 30.1%. Only 8.3% of the SDB was primarily central apnea. Seventeen studies reported risk factors for OSA, 6 of which used multivariate analyses to extract risk factors. In univariate meta-regression analysis, male had higher prevalence than female (P = .041). OSA was associated with increased length of hospitalization in 2 studies, and 1 long-term study reported severe sleep apnea was associated with poor functional outcome. Among the 5 studies on treatment, 3 indicated that early treatment with CPAP was effective; the remaining studies did not find benefit from CPAP treatment and reported the CPAP acceptance was poor.

CONCLUSIONS

There is high prevalence of OSA in patients with CVD (61.9%). Therefore, accurate diagnosis and treatment to OSA is very important so as to prevent CVD.

摘要

背景

阻塞性睡眠呼吸暂停(OSA)已知会增加脑血管疾病(CVD)的风险,而CVD患者中OSA的发病率很高。本研究旨在系统评估CVD患者中OSA的患病率。

材料与方法

全面检索了医学期刊数据库(Medline)、荷兰医学文摘数据库(Embase)、科学引文索引、万方数据库、中国知网和威利在线图书馆,以确定相关研究。采用随机效应模型计算合并率估计值。进行了Meta回归和亚组分析,以探索异质性的潜在来源。

结果

分析了37项研究中的3242例患者。OSA(呼吸暂停低通气指数[AHI]>10)的患病率在34.5%至92.3%之间,随机效应合并患病率为61.9%。此外,AHI大于5的睡眠呼吸障碍(SDB)患病率为70.4%,AHI大于20的为39.5%,AHI大于30的为30.1%。SDB中仅8.3%主要为中枢性呼吸暂停。17项研究报告了OSA的危险因素,其中6项使用多变量分析提取危险因素。在单变量Meta回归分析中,男性患病率高于女性(P = 0.041)。2项研究中OSA与住院时间延长有关,1项长期研究报告严重睡眠呼吸暂停与功能预后不良有关。在5项关于治疗的研究中,3项表明早期使用持续气道正压通气(CPAP)治疗有效;其余研究未发现CPAP治疗有益,并报告CPAP接受度较差。

结论

CVD患者中OSA的患病率很高(61.9%)。因此,准确诊断和治疗OSA对于预防CVD非常重要。

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