School of Electrical and Electronic Engineering, University of Adelaide, North Terrace, Adelaide, SA 5000, Australia.
California Pacific Medical Center Research Institute, Brannan Street, San Francisco, CA 94107, USA.
Eur Heart J. 2020 Jan 21;41(4):533-541. doi: 10.1093/eurheartj/ehy838.
To investigate the composition of nocturnal hypoxaemic burden and its prognostic value for cardiovascular (CV) mortality in community-dwelling older men.
We analysed overnight oximetry data from polysomnograms obtained in 2840 men from the Outcomes of Sleep Disorders in Older Men (MrOS Sleep) study (ClinicalTrials.gov Identifier: NCT00070681) to determine the number of acute episodic desaturations per hour (oxygen desaturation index, ODI) and time spent below 90% oxygen saturation (T90) attributed to acute desaturations (T90desaturation) and to non-specific drifts in oxygen saturation (T90non-specific), respectively, and their relationship with CV mortality. After 8.8 ± 2.7 years follow-up, 185 men (6.5%) died from CV disease. T90 [hazard ratio (HR) 1.21, P < 0.001], but not ODI (HR 1.13, P = 0.06), was significantly associated with CV death in univariate analysis. T90 remained significant when adjusting for potential confounders (HR 1.16, P = 0.004). Men with T90 > 12 min were at an elevated risk of CV mortality (HR 1.59; P = 0.006). Approximately 20.7 (5.7-48.5) percent of the variation in T90 could be attributed to non-specific drifts in oxygen saturation. T90desaturation and T90non-specific were individually associated with CV death but combining both variables did not improve the prediction.
In community-dwelling older men, T90 is an independent predictor of CV mortality. T90 is not only a consequence of frank desaturations, but also reflects non-specific drifts in oxygen saturation, both contributing towards the association with CV death. Whether T90 can be used as a risk marker in the clinical setting and whether its reduction may constitute a treatment target warrants further study.
研究社区居住的老年男性夜间低氧负担的构成及其对心血管（CV）死亡率的预后价值。
我们分析了来自 Outcomes of Sleep Disorders in Older Men（MrOS Sleep）研究（ClinicalTrials.gov 标识符：NCT00070681）中 2840 名男性的多导睡眠图过夜血氧仪数据，以确定每小时急性发作性脱氧的次数（氧减指数，ODI）和由于急性脱氧（T90 脱氧）和氧饱和度非特异性漂移（T90 非特异性）而导致的氧饱和度低于 90%的时间（T90 非特异性），并分别研究它们与 CV 死亡率的关系。在 8.8±2.7 年的随访后，185 名男性（6.5%）死于 CV 疾病。T90[风险比（HR）1.21，P<0.001]，但 ODI（HR 1.13，P=0.06）在单变量分析中与 CV 死亡无显著相关性。在调整潜在混杂因素后，T90 仍然具有统计学意义（HR 1.16，P=0.004）。T90>12 分钟的男性 CV 死亡率升高（HR 1.59；P=0.006）。T90 变异的约 20.7%（5.7-48.5）可以归因于氧饱和度的非特异性漂移。T90 脱氧和 T90 非特异性均与 CV 死亡相关，但联合两种变量并不能提高预测效果。
在社区居住的老年男性中，T90 是 CV 死亡率的独立预测因子。T90 不仅是明显脱氧的结果，还反映了氧饱和度的非特异性漂移，两者都与 CV 死亡相关。T90 是否可以作为临床环境中的风险标志物，以及降低 T90 是否可以作为治疗目标，还需要进一步研究。
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