Department of Cardiology, Respiratory Medicine and Intensive Care, Klinikum Augsburg, Ludwig-Maximilians-University Munich, Stenglinstrasse 2, 86156, Augsburg, Germany.
Department of Radiology, Klinikum Augsburg, Ludwig-Maximilians-University Munich, Stenglinstrasse 2, 86156, Augsburg, Germany.
J Thromb Thrombolysis. 2018 Aug;46(2):253-259. doi: 10.1007/s11239-018-1665-7.
Obstructive sleep apnea (OSA) might influence disease severity in acute pulmonary embolism (PE). 253 survivors of acute PE were evaluated for sleep-disordered breathing by portable monitoring and nocturnal polysomnography. PE patients with an apnea-hypopnoea index (AHI) ≥ 15/h were significantly older (p < 0.001), had significantly impaired renal (p < 0.001) and left ventricular functions (p = 0.003), showed significantly elevated troponin I (p = 0.005) and D-dimer levels (p = 0.024), were hospitalised significantly longer (p < 0.001), and had significantly elevated PE severity scores (p = 0.015). Moderate or severe OSA was significantly (p = 0.006) more frequent among intermediate- and high-risk PE patients (81.0%) compared to the low-risk PE cohort (16.3%). Multiple logistic regression analysis revealed that PE patients in the AHI ≥ 15/h cohort were at significant risk for myocardial injury (p = 0.015). Based on clinical risk stratification models, patients with no relevant OSA syndrome tended to be at a lower risk for short-term mortality (p = 0.068). Acute PE might present more severely in OSA patients, possibly due to nocturnal hypoxemia or OSA-related hypercoagulability.
阻塞性睡眠呼吸暂停（OSA）可能会影响急性肺栓塞（PE）的疾病严重程度。通过便携式监测和夜间多导睡眠图评估了 253 例急性 PE 幸存者的睡眠呼吸障碍情况。呼吸暂停低通气指数（AHI）≥15/h 的 PE 患者明显更年长（p<0.001），肾功能（p<0.001）和左心室功能明显受损（p=0.003），肌钙蛋白 I（p=0.005）和 D-二聚体水平明显升高（p=0.024），住院时间明显延长（p<0.001），PE 严重程度评分明显升高（p=0.015）。中危和高危 PE 患者（81.0%）中，中度或重度 OSA 的发生率明显高于低危 PE 队列（16.3%）（p=0.006）。多变量逻辑回归分析显示，AHI≥15/h 组的 PE 患者发生心肌损伤的风险显著增加（p=0.015）。基于临床风险分层模型，无相关 OSA 综合征的患者短期死亡率较低（p=0.068）。OSA 患者的急性 PE 可能表现更严重，可能是由于夜间低氧血症或 OSA 相关的高凝状态。
