Research, Mayo Clinic, Jacksonville, Florida.
Anesthesia Clinical Research, Mayo Clinic, Rochester, Minnesota.
J Clin Sleep Med. 2020 Jul 15;16(7):1029-1036. doi: 10.5664/jcsm.8380.
The objectives of this study were to assess the effect of obstructive sleep apnea (OSA) on the risk of acute pulmonary embolism (PE), hospital outcomes including mortality, and PE recurrence.
We retrospectively enrolled adult patients, admitted to Mayo Clinic Hospital in Rochester, Minnesota, within a 5-year period (2009-2013). We compared frequency of PE, hospital mortality, and secondary outcomes in patients with OSA versus patients without OSA. We assessed risk of PE recurrence in relation to compliance with OSA therapy.
Of 25,038 patients, 3,184 (13%) had OSA and 283 (1.1%) experienced PE. Frequency of PE in patients with and without OSA was 2.4% versus 0.9% (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.9-3.3; P < .001). OSA was independently associated with increased risk of PE after adjusting for demographics and comorbidities (OR, 1.44; 95% CI, 1.07-1.9; P = .017). Adjusted hospital mortality was increased in patients with PE (OR, 2.88; 95% CI, 1.7-4.9; P < .001) but not in patients with OSA (OR, 0.98; 95% CI, 0.7-1.4, P = .92). OSA was not a significant determining factor for mortality in patients who experienced a PE (OR, 0.56; 95% CI, 0.1.1-2.78; P = .47), adjusting for demographics, PE severity, and Charlson comorbidity index. Adjusted risk of PE recurrence was greater in patients with OSA compared with patients without OSA (OR, 2.21; 95% CI, 1.05-4.68; P < .04). The patients compliant with OSA therapy had a lower rate of PE recurrence (16% vs 32%; P = not significant).
Although OSA significantly increases risk of acute PE occurrence and recurrences, related hospital mortality was not greater in patients with OSA compared with those without OSA. OSA therapy might have a modifying effect on PE recurrence.
本研究旨在评估阻塞性睡眠呼吸暂停（OSA）对急性肺栓塞（PE）风险、包括死亡率在内的住院结局以及 PE 复发的影响。
我们回顾性纳入了在明尼苏达州罗切斯特市梅奥诊所医院住院的成年患者，纳入时间为 5 年（2009-2013 年）。我们比较了 OSA 患者和非 OSA 患者的 PE 发生率、住院死亡率和次要结局。我们评估了 OSA 治疗依从性与 PE 复发风险之间的关系。
在 25038 名患者中，3184 名（13%）患有 OSA，283 名（1.1%）发生了 PE。有 OSA 和无 OSA 的患者中 PE 的发生率分别为 2.4%和 0.9%（比值比[OR]，2.51；95%置信区间[CI]，1.9-3.3；P<0.001）。在调整了人口统计学和合并症后，OSA 与 PE 风险增加独立相关（OR，1.44；95%CI，1.07-1.9；P=0.017）。PE 患者的调整后住院死亡率升高（OR，2.88；95%CI，1.7-4.9；P<0.001），但 OSA 患者的死亡率未升高（OR，0.98；95%CI，0.7-1.4，P=0.92）。在经历 PE 的患者中，OSA 不是决定死亡率的重要因素（OR，0.56；95%CI，0.1.1-2.78；P=0.47），这一结果在调整了 PE 严重程度和 Charlson 合并症指数后仍然成立。与无 OSA 患者相比，OSA 患者的 PE 复发风险更高（OR，2.21；95%CI，1.05-4.68；P<0.04）。接受 OSA 治疗的患者的 PE 复发率较低（16% vs 32%；P=无显著意义）。
尽管 OSA 显著增加了急性 PE 发生和复发的风险，但与无 OSA 患者相比，OSA 患者的相关住院死亡率并未增加。OSA 治疗可能对 PE 复发具有调节作用。
