Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark.
J Am Heart Assoc. 2018 Jun 22;7(13):e008684. doi: 10.1161/JAHA.118.008684.
Whether there is an association between sleep apnea (SA) and the risk of developing heart failure (HF) is unclear. Furthermore, it has never been established whether continuous positive airway pressure (CPAP) therapy can prevent development of HF. We aimed to investigate SA patients' risk of developing HF and the association of CPAP therapy.
Using nationwide databases, the entire Danish population was followed from 2000 until 2012. patients with SA receiving and not receiving CPAP therapy were identified and compared with the background population. The primary end point was first-time hospital contact for HF and adjusted incidence rate ratios of HF were calculated using Poisson regression models. Among 4.9 million individuals included, 40 485 developed SA during the study period (median age: 53.4 years, 78.5% men) of whom 45.2% received CPAP therapy. Crude rates of HF were increased in all patients with SA relative to the background population. In the adjusted model, the incidence rate ratios of HF were increased in the untreated SA patients of all ages, compared with the background population. Comparing the CPAP-treated patients with SA with the untreated patients with SA showed significantly lower incidence rate ratios of HF among older patients.
In this nationwide cohort study, SA not treated with CPAP was associated with an increased risk of HF in patients of all ages. Use of CPAP therapy was associated with a lower risk of incident HF in patients >60 years of age, suggesting a protective effect of CPAP therapy in the elderly.
睡眠呼吸暂停（SA）与心力衰竭（HF）风险之间是否存在关联尚不清楚。此外，持续气道正压通气（CPAP）治疗是否可以预防 HF 的发展也尚未确定。我们旨在研究 SA 患者发生 HF 的风险以及 CPAP 治疗的相关性。
使用全国性数据库，对 2000 年至 2012 年期间的整个丹麦人群进行了随访。确定了接受和未接受 CPAP 治疗的 SA 患者，并将其与背景人群进行了比较。主要终点是首次因 HF 住院，使用泊松回归模型计算 HF 的调整发病率比值。在纳入的 490 万人中，40485 人在研究期间出现 SA（中位年龄：53.4 岁，78.5%为男性），其中 45.2%接受 CPAP 治疗。与背景人群相比，所有 SA 患者的 HF 粗发生率均增加。在调整模型中，与背景人群相比，所有年龄段未经治疗的 SA 患者 HF 的发病率比值均增加。与未接受 CPAP 治疗的 SA 患者相比，CPAP 治疗的 SA 患者中年龄较大的患者 HF 的发病率比值明显较低。
在这项全国性队列研究中，未经 CPAP 治疗的 SA 与所有年龄段患者 HF 风险增加相关。CPAP 治疗与 >60 岁患者的新发 HF 风险降低相关，提示 CPAP 治疗对老年人具有保护作用。
