Department of Internal Medicine, Hsiao Chung-Cheng Hospital, New Taipei, Taiwan.
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
PLoS One. 2018 Jul 30;13(7):e0201493. doi: 10.1371/journal.pone.0201493. eCollection 2018.
The present study aimed to test if the temporal sequence between sleep apnea (SA) diagnosis and incident myocardial infarction (MI) was associated with the long-term mortality and cardiovascular event in a community-based cohort.
We retrieved data from 9,453 incident MI patients between Jan. 1st 2000 and Dec. 31st 2012 from the Taiwan National Health Insurance Research Database. The study subjects included 207 MI patients with SA (SA-MI), further stratified into 110 with pre-existing SA before MI (SA-bMI) and 96 diagnosed with SA after MI (SA-pMI). The median follow-up period was 4.2 years. Propensity-score-matched controls were selected from 9,246 non-SA MI patients (non-SA-MI). The association of SA and outcomes including all-cause mortality and major adverse cardiac and cerebrovascular events (MACCEs) were analyzed by a Cox proportional hazards model.
The result showed that SA was not associated with mortality regardless of the timing of SA diagnosis. SA-pMI was associated with increased risk of MACCEs (Hazard ratio [HR]: 1.412, 95% confidence interval [CI]: 1.0371.923, p = 0.029) including re-MI or revascularization and ischemic heart disease hospitalization. Such an association was most significant for SA diagnosed within one year after MI (HR: 2.029, 95% CI: 1.2653.254, p = 0.003), which was not seen in patients treated with continuous positive airway pressure (CPAP).
The temporal sequence and the time interval between SA diagnosis and incident MI was associated with the cardiovascular events after MI, especially within one year after MI. Early assessment for the presence of SA after incident MI and early CPAP intervention may reduce the risk of further adverse cardiovascular events.
本研究旨在检验睡眠呼吸暂停（SA）诊断与心肌梗死（MI）事件之间的时间顺序是否与基于社区队列的长期死亡率和心血管事件相关。
我们从台湾全民健康保险研究数据库中检索了 2000 年 1 月 1 日至 2012 年 12 月 31 日期间 9453 例新发 MI 患者的数据。研究对象包括 207 例患有 SA 的 MI 患者（SA-MI），进一步分为 110 例在 MI 前就存在 SA（SA-bMI）和 96 例在 MI 后诊断为 SA（SA-pMI）的患者。中位随访时间为 4.2 年。从 9246 例非 SA-MI 患者（非 SA-MI）中选择倾向评分匹配对照。采用 Cox 比例风险模型分析 SA 与全因死亡率和主要不良心脏和脑血管事件（MACCEs）等结局的相关性。
结果显示，无论 SA 诊断时间如何，SA 与死亡率无关。SA-pMI 与 MACCEs 风险增加相关（风险比[HR]：1.412，95%置信区间[CI]：1.0371.923，p = 0.029），包括再发 MI 或血运重建和缺血性心脏病住院。这种相关性在 MI 后一年内诊断为 SA 的患者中最为显著（HR：2.029，95%CI：1.2653.254，p = 0.003），而在接受持续气道正压通气（CPAP）治疗的患者中则没有。
SA 诊断与 MI 事件之间的时间顺序和时间间隔与 MI 后心血管事件相关，尤其是在 MI 后一年内。对 MI 后 SA 的存在进行早期评估和早期 CPAP 干预可能会降低进一步发生不良心血管事件的风险。
