种族、性别、年龄和地区差异对阻塞性睡眠呼吸暂停与心房颤动相关性的影响：卒中地理和种族差异研究的原因。
Race, Sex, Age, and Regional Differences in the Association of Obstructive Sleep Apnea With Atrial Fibrillation: Reasons for Geographic and Racial Differences in Stroke Study.
机构信息
Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
出版信息
J Clin Sleep Med. 2018 Sep 15;14(9):1485-1493. doi: 10.5664/jcsm.7320.
STUDY OBJECTIVES
To examine the cross-sectional association between obstructive sleep apnea (OSA) risk and atrial fibrillation (AF) in the REasons for Geographic And Racial Differences in Stroke (REGARDS), a cohort of black and white adults.
METHODS
Using REGARDS data from subjects recruited between 2003-2007, we assessed 20,351 participants for OSA status. High OSA risk was determined if the participant met at least two criteria from the Berlin Sleep Questionnaire (persistent snoring, frequent sleepiness, high blood pressure, or obesity). AF was defined as a self-reported history of a previous physician diagnosis or presence of AF on electrocardiogram. Logistic regression was used to determine odds ratio and 95% confidence interval for the association between OSA status and AF with subgroup analysis to examine effect modification by age, race, sex, and geographical region.
RESULTS
The prevalence of AF was 7% (n = 1,079/14,992) and 9% (n = 482/5,359) in participants at low and high risk of OSA, respectively ( < .0001). Persons at high risk of OSA had greater prevalence of diabetes and stroke history, and were more likely to be obese and taking sleep medications. In a multivariable analysis adjusted for demographics, cardiovascular risk factors, and potential confounders, high risk for OSA was associated with an increased odds of AF compared to low risk for OSA (odds ratio = 1.27, 95% confidence interval = 1.13, 1.44). This association differed significantly only by race ( for interaction = .0003). For blacks, there was a significant 58% increase in odds of AF in participants at high risk versus low risk of OSA, compared to a nonsignificant 12% increase in odds in whites. We were limited by self-reported variables, inability to adjust for obesity, and the cross-sectional nature of our study.
CONCLUSIONS
High risk of OSA is associated with prevalent AF among blacks but not whites.
COMMENTARY
A commentary on this article appears in this issue on page 1459.
研究目的
在 Reasons for Geographic And Racial Differences in Stroke（REGARDS）队列中，检查阻塞性睡眠呼吸暂停（OSA）风险与心房颤动（AF）之间的横断面关联，该队列由黑人和白人成年人组成。
方法
使用 2003-2007 年招募的 REGARDS 数据，我们评估了 20351 名参与者的 OSA 状况。如果参与者符合柏林睡眠问卷中的至少两个标准（持续打鼾、频繁嗜睡、高血压或肥胖），则确定存在高 OSA 风险。AF 定义为既往医生诊断或心电图上存在 AF 的自述病史。使用逻辑回归确定 OSA 状态与 AF 之间的比值比和 95%置信区间，并进行亚组分析，以检查年龄、种族、性别和地理区域的效应修饰作用。
结果
AF 的患病率分别为低 OSA 风险组为 7%（n = 1,079/14,992）和高 OSA 风险组为 9%（n = 482/5,359）（<.0001）。高 OSA 风险者更常见糖尿病和中风病史，更可能肥胖并服用睡眠药物。在调整人口统计学、心血管危险因素和潜在混杂因素的多变量分析中，与低 OSA 风险相比，高 OSA 风险与 AF 的发生几率增加相关（比值比=1.27，95%置信区间=1.13，1.44）。这种关联仅因种族而显著不同（交互作用=.0003）。对于黑人，与低 OSA 风险相比，高 OSA 风险参与者的 AF 发生几率增加了 58%，而白人的几率增加了 12%，没有显著差异。我们受到自我报告变量的限制，无法调整肥胖因素，并且我们的研究具有横断面性质。
结论
高 OSA 风险与黑人中常见的 AF 相关，但与白人中不相关。
评论
对此文的评论见本期第 1459 页。
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