正压通气治疗阻塞性和中枢性睡眠呼吸暂停对介入后心房颤动/扑动复发的影响。
The Effect of Positive Airway Pressure Treatment of Obstructive and Central Sleep Apnea on the Recurrence of Atrial Fibrillation/Flutter Postintervention.
机构信息
Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
出版信息
J Clin Sleep Med. 2019 Oct 15;15(10):1459-1468. doi: 10.5664/jcsm.7976.
STUDY OBJECTIVES
A strong association between sleep-disordered breathing (SDB) and atrial fibrillation and/or atrial flutter (AF) has consistently been observed in epidemiologic and interventional studies. The effect of positive airway pressure (PAP) on AF recurrence is inconclusive. This study sought to evaluate the effectiveness of PAP therapy for SDB on AF recurrence.
METHODS
This was a single-center, retrospective study conducted at a tertiary referral center. All adult patients who had SDB on polysomnography and underwent AF intervention (ablation or cardioversion) following polysomnography from January 1992-December 2014 were analyzed. Primary outcome was time to first-documented recurrence of AF after AF intervention by Kaplan-Meier estimates.
RESULTS
Among 30,188 patients with obstructive and central SDB, 429 had this diagnosis before AF intervention; 269 were "PAP-adherent users," the remaining 160 were "PAP-nonusers." Patients in both groups had similar age, sex, body mass index (BMI), ejection fraction, left atrial volume index (LAVI), antiarrhythmic medications, diabetes mellitus, systemic hypertension, and heart failure diagnoses. Time to recurrence of AF postintervention was no different in PAP-adherent users and nonusers (4.8 and 4.1 months respectively, P = .7). Cardioversion (compared to catheter ablation) was the strongest independent predictor of recurrent AF (hazard ratio [HR] 2.02, 95% confidence interval [CI] 1.39-2.94, P < .001). BMI and LAVI were also significant predictors of recurrence in adjusted analyses (HR 1.01, 95% CI 1.003-1.023, P = .10 and HR 1.01, 95% CI 1.001-1.019, P = .024 respectively).
CONCLUSIONS
Our study found no effect of PAP treatment of SDB on time to recurrence of AF post-AF intervention. Increased risk of recurrent AF was associated with high BMI and LAVI. These findings may affect the clinical management of AF.
研究目的
在流行病学和干预研究中，一直观察到睡眠呼吸障碍（SDB）与心房颤动和/或心房扑动（AF）之间存在很强的关联。气道正压通气（PAP）对 AF 复发的影响尚无定论。本研究旨在评估 SDB 的 PAP 治疗对 AF 复发的有效性。
方法
这是一项在三级转诊中心进行的单中心回顾性研究。分析了 1992 年 1 月至 2014 年 12 月期间行睡眠呼吸监测（PSG）并随后根据 PSG 行 AF 介入（消融或电复律）的所有成人患者。主要结局是通过 Kaplan-Meier 估计首次记录到的 AF 复发时间。
结果
在 30188 例阻塞性和中枢性 SDB 患者中，429 例患者在 AF 介入前有此诊断；269 例为“PAP 依从性使用者”，其余 160 例为“PAP 非使用者”。两组患者的年龄、性别、体重指数（BMI）、射血分数、左心房容积指数（LAVI）、抗心律失常药物、糖尿病、高血压和心力衰竭诊断均相似。介入后 AF 复发时间在 PAP 依从性使用者和非使用者之间无差异（分别为 4.8 个月和 4.1 个月，P =.7）。与导管消融相比，电复律（cardioversion）是 AF 复发的最强独立预测因素（风险比[HR] 2.02，95%置信区间[CI] 1.39-2.94，P <.001）。调整分析中，BMI 和 LAVI 也是复发的显著预测因素（HR 1.01，95% CI 1.003-1.023，P =.10；HR 1.01，95% CI 1.001-1.019，P =.024）。
结论
我们的研究发现，AF 介入后 SDB 的 PAP 治疗对 AF 复发时间无影响。AF 复发风险增加与 BMI 高和 LAVI 高有关。这些发现可能会影响 AF 的临床管理。
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