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阻塞性睡眠呼吸暂停与心血管危险因素密切相关,但与导管消融术后心房颤动的临床复发无关:一项心房颤动患者的分析。

Obstructive Sleep Apnea Is Closely Related to Cardiovascular Risk Factors, but Not to Clinical Recurrence of Atrial Fibrillation after Catheter Ablation: An Analysis of Atrial Fibrillation Patients.

作者信息

Lee Chan Joo, Kim Tae-Hoon, Park Sungha, Pak Hui-Nam

机构信息

Department of Health Promotion, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.

出版信息

Pulse (Basel). 2018 Jul;6(1-2):103-111. doi: 10.1159/000489854. Epub 2018 Jul 18.

Abstract

BACKGROUND

Obstructive sleep apnea (OSA) is a well-known predictor of atrial fibrillation (AF). However, OSA usually accompanies other risk factors of AF. We tried to investigate whether OSA is related to AF recurrence after catheter ablation.

METHODS

A total of 378 patients (mean age 59.9 ± 10.7 years, 72.5$ male) who underwent catheter ablation of AF were enrolled and underwent overnight ambulatory polysomnography before the ablation procedure. These patients were examined once every 3 months at the outpatient clinic to determine AF recurrence.

RESULTS

Based on the apnea-hypopnea index (AHI), we divided the study subjects into 3 groups defined as mild (AHI < 10), moderate (10 <AHI < 30), or severe (AHI > 30) OSA. Patients with severe OSA had a higher prevalence of hypertension, diabetes mellitus, and coronary artery disease (CAD). However, AF recurrence was not different between the three groups. The Kaplan-Meier analysis also showed no significant difference in AF recurrence according to the degree of severity of OSA. Multivariate logistic regression analysis revealed that OSA might be a predictor of CAD; however, Cox regression analysis showed that only early recurrence is closely related to AF recurrence after catheter ablation, rather than the severity of OSA.

CONCLUSION

This study shows that the severity of OSA is not associated with the recurrence of AF after catheter ablation in Korean patients. Treatment of OSA for the sole indication of lowering AF recurrence may need to be reconsidered.

摘要

背景

阻塞性睡眠呼吸暂停(OSA)是心房颤动(AF)的一个众所周知的预测指标。然而,OSA通常伴有AF的其他危险因素。我们试图研究OSA是否与导管消融术后AF复发有关。

方法

共有378例接受AF导管消融术的患者(平均年龄59.9±10.7岁,72.5%为男性)入组,并在消融术前接受夜间动态多导睡眠监测。这些患者在门诊每3个月检查一次,以确定AF复发情况。

结果

根据呼吸暂停低通气指数(AHI),我们将研究对象分为3组,定义为轻度(AHI<10)、中度(10<AHI<30)或重度(AHI>30)OSA。重度OSA患者高血压、糖尿病和冠状动脉疾病(CAD)的患病率较高。然而,三组之间的AF复发情况并无差异。Kaplan-Meier分析也显示,根据OSA严重程度,AF复发无显著差异。多因素逻辑回归分析显示,OSA可能是CAD的一个预测指标;然而,Cox回归分析表明,只有早期复发与导管消融术后AF复发密切相关,而非OSA的严重程度。

结论

本研究表明,在韩国患者中,OSA的严重程度与导管消融术后AF复发无关。仅为降低AF复发而治疗OSA可能需要重新考虑。

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