SAVE研究中阻塞性睡眠呼吸暂停患者心血管事件复发的高危特征。

High Risk Characteristics for Recurrent Cardiovascular Events among Patients with Obstructive Sleep Apnoea in the SAVE Study.

作者信息

Quan Weiwei, Zheng Danni, Douglas McEvoy R, Barbe Ferran, Chen Riu, Liu Zhihong, Loffler Kelly, Lorenzi-Filho Geraldo, Luo Yuanming, Mukherjee Sutapa, Tripathi Manjari, Woodman Richard, Li Qiang, Wang Xia, Arima Hisatomi, Xiao Yi, Zhang Xilong, Anderson Craig S

机构信息

Department of Cardiology, Rui Jin Hospital and Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.

出版信息

EClinicalMedicine. 2018 Sep 21;2-3:59-65. doi: 10.1016/j.eclinm.2018.09.002. eCollection 2018 Aug-Sep.

DOI:10.1016/j.eclinm.2018.09.002

PMID:31193555

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6537527/

Abstract

BACKGROUND

Obstructive sleep apnoea (OSA) is a common comorbidity in patients with cardiovascular (CV) disease. We aimed to identify specific OSA clinical phenotypes relating to risks of serious CV events and response to continuous positive airway pressure (CPAP) treatment.

METHODS

Post-hoc analyses of the Sleep Apnea Cardiovascular Endpoints (SAVE) study in participants with moderate-to-severe OSA and coronary artery disease (CAD) and/or cerebrovascular disease (CeVD) randomised to CPAP plus usual care or usual care alone. Latent class analysis (LCA) was used to identify OSA clinical phenotypes among 2649 (out of 2687 total) patients with complete data on 19 patient-centered variables, supported by Bayesian information criteria and clinical interpretability. Cox regression models were used to evaluate risks of composite cardiac and stroke outcome events in phenotype groups. Preferential response to CPAP treatment was evaluated using interaction terms as well as the Chi-square test.

FINDINGS

LCA identified four OSA clinical phenotypes: CAD alone and with diabetes mellitus (CAD + DM), and CeVD alone and with DM (CeVD + DM), in 39%, 15%, 37% and 9% of participants, respectively. The rates of composite CV events were the highest in CAD + DM phenotype (HR 2.08, 95% CI 1.57-2.76) and for stroke were highest in CeVD + DM phenotype (HR 6.84, 95% CI 3.77-12.42). Adherence to CPAP treatment (nil or < 4 h vs ≥ 4 h in the first two years of the study) was shown to influence the risk of composite CV outcome in the phenotypes (P-interaction = 0.04); CPAP adherent patients of the CeVD + DM phenotype had the lowest risk of CV outcome (P = 0.02).

INTERPRETATION

High risk clinical phenotypes were identified in relation to CV events and response to CPAP treatment, which may allow improved targeting of therapies in OSA patients.

FUNDING

The National Health and Medical Research Council (NHMRC) of Australia, Fisher & Paykel Healthcare, and ResMed.

摘要

背景

阻塞性睡眠呼吸暂停（OSA）是心血管（CV）疾病患者中常见的合并症。我们旨在确定与严重CV事件风险及持续气道正压通气（CPAP）治疗反应相关的特定OSA临床表型。

方法

对睡眠呼吸暂停心血管终点（SAVE）研究进行事后分析，该研究纳入了中度至重度OSA且患有冠状动脉疾病（CAD）和/或脑血管疾病（CeVD）的参与者，他们被随机分配接受CPAP加常规护理或仅接受常规护理。潜在类别分析（LCA）用于在2687名参与者中的2649名（有完整数据）患者中识别OSA临床表型，这些患者有19个以患者为中心的变量数据，并由贝叶斯信息准则和临床可解释性提供支持。Cox回归模型用于评估表型组中复合心脏和中风结局事件的风险。使用交互项以及卡方检验评估对CPAP治疗的优先反应。

结果

LCA识别出四种OSA临床表型：仅患有CAD且患有糖尿病（CAD + DM），以及仅患有CeVD且患有糖尿病（CeVD + DM），分别占参与者的39%、15%、37%和9%。复合CV事件发生率在CAD + DM表型中最高（HR 2.08，95%CI 1.57 - 2.76），中风发生率在CeVD + DM表型中最高（HR 6.84，95%CI 3.77 - 12.42）。研究显示，在研究的前两年中，CPAP治疗的依从性（无或<4小时与≥4小时）会影响表型中复合CV结局的风险（P交互作用 = 0.04）；CeVD + DM表型中坚持使用CPAP的患者CV结局风险最低（P = 0.02）。