University of Tennessee College of Medicine, Chattanooga, Department of Respiratory, Critical Care, and Sleep Medicine, Chattanooga, Tennessee.
UHS Wilson Medical Center, Department of Cardiovascular Disease, Johnson City, New York.
J Clin Sleep Med. 2020 Jul 15;16(7):1107-1117. doi: 10.5664/jcsm.8438.
The relationship between obstructive sleep apnea (OSA) and heart failure (HF) incidence in postmenopausal women has been understudied, given the limited representation of women in heart failure studies. We investigated the relationship between OSA risk factors and HF and its subtypes in postmenopausal women.
We performed a prospective analysis on the adjudicated HF outcomes in the Women's Health Initiative from enrollment (1993-1998) to September 30, 2016. HF with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF) were defined as adjudicated acute HF hospitalization with EF ≥ 45% or < 45%, respectively. We employed Cox regression to examine the association between OSA risk factors and symptoms (individually and using a summary risk score) and time to first hospitalized HF.
Of 42,362 women, 2,205 (5.21%) developed all HF, 1,162 (2.74%) women developed HFpEF, and 679 (1.60%) developed HFrEF. Individual OSA risk factors and symptoms, including obesity (hazard ratio = 1.33, 95% confidence interval [CI] 1.20-1.48), snoring (hazard ratio = 1.30, 95% CI 1.16-1.46), and hypertension (HR = 1.45, 95% CI 1.35-1.56), were positively associated with risk of HF and HFpEF, but only hypertension was associated with HFrEF. When examined as a summary risk score compared with those with none of the OSA risk factors, presence of each additional factor was significantly associated with increased risk of hospitalized HF in a dose-response fashion for HFpEF (P trend < .001), but not HFrEF (P trend = .26).
OSA risk factors and symptoms were associated with HFpEF, but not HFrEF, among postmenopausal women and are largely dependent on body mass index, snoring, and hypertension.
鉴于心力衰竭研究中女性代表性有限，绝经后女性阻塞性睡眠呼吸暂停（OSA）与心力衰竭（HF）发病率之间的关系尚未得到充分研究。我们调查了绝经后妇女中 OSA 危险因素与 HF 及其亚型的关系。
我们对 Women's Health Initiative 从入组（1993-1998 年）到 2016 年 9 月 30 日期间经裁决的 HF 结局进行了前瞻性分析。射血分数保留的心力衰竭（HFpEF）和射血分数降低的心力衰竭（HFrEF）分别定义为 EF≥45%或<45%的经裁决的急性 HF 住院。我们采用 Cox 回归分析检查 OSA 危险因素和症状（单独和使用综合风险评分）与首次住院 HF 之间的关系。
在 42362 名女性中，2205 名（5.21%）发生了所有 HF，1162 名（2.74%）发生了 HFpEF，679 名（1.60%）发生了 HFrEF。个体 OSA 危险因素和症状，包括肥胖（危险比=1.33，95%置信区间[CI]1.20-1.48）、打鼾（危险比=1.30，95%CI1.16-1.46）和高血压（HR=1.45，95%CI1.35-1.56），与 HF 和 HFpEF 的风险呈正相关，但只有高血压与 HFrEF 相关。当作为综合风险评分进行检查时，与没有任何 OSA 危险因素的女性相比，存在每增加一个危险因素与 HFpEF 的住院 HF 风险呈剂量反应式增加（趋势 P<0.001），但与 HFrEF 无关（趋势 P=0.26）。
OSA 危险因素和症状与绝经后妇女的 HFpEF 相关，但与 HFrEF 无关，主要取决于体重指数、打鼾和高血压。
