Department of Cardiology, National University Heart Centre, Singapore
Department of Cardiology, National University Heart Centre, Singapore.
Heart. 2020 Oct;106(19):1495-1502. doi: 10.1136/heartjnl-2019-316118. Epub 2020 May 18.
Patients with advanced coronary artery disease are referred for coronary artery bypass grafting (CABG) and it remains unknown if sleep apnoea is a risk marker. We evaluated the association between sleep apnoea and major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing non-emergent CABG.
This was a prospective cohort study conducted between November 2013 and December 2018. Patients from four public hospitals referred to a tertiary cardiac centre for non-emergent CABG were recruited for an overnight sleep study using a wrist-worn Watch-PAT 200 device prior to CABG.
Among the 1007 patients who completed the study, sleep apnoea (defined as apnoea-hypopnoea index ≥15 events per hour) was diagnosed in 513 patients (50.9%). Over a mean follow-up period of 2.1 years, 124 patients experienced the four-component MACCE (2-year cumulative incidence estimate, 11.3%). There was a total of 33 cardiac deaths (2.5%), 42 non-fatal myocardial infarctions (3.7%), 50 non-fatal strokes (4.9%) and 36 unplanned revascularisations (3.2%). The crude incidence of MACCE was higher in the sleep apnoea group than the non-sleep apnoea group (2-year estimate, 14.7% vs 7.8%; p=0.002). Sleep apnoea predicted the incidence of MACCE in unadjusted Cox regression analysis (HR 1.69; 95% CI 1.18 to 2.43), and remained statistically significant (adjusted HR 1.57; 95% CI 1.09 to 2.25), after adjustment for age, sex, body mass index, left ventricular ejection fraction, diabetes mellitus, hypertension, chronic kidney disease and excessive daytime sleepiness.
Sleep apnoea is independently associated with increased MACCE in patients undergoing CABG.
NCT02701504.
患有晚期冠状动脉疾病的患者被转诊进行冠状动脉旁路移植术（CABG），目前尚不清楚睡眠呼吸暂停是否是一个风险标志物。我们评估了非紧急 CABG 患者中睡眠呼吸暂停与主要不良心脏和脑血管事件（MACCE）之间的关联。
这是一项前瞻性队列研究，于 2013 年 11 月至 2018 年 12 月进行。从四家公立医院转诊到三级心脏中心进行非紧急 CABG 的患者，在 CABG 前使用腕戴式 Watch-PAT 200 设备进行了一夜睡眠研究。
在完成研究的 1007 名患者中，513 名（50.9%）被诊断为睡眠呼吸暂停（定义为每小时呼吸暂停-低通气指数≥15 次）。在平均 2.1 年的随访期间，124 名患者经历了四部分 MACCE（2 年累积发生率估计值为 11.3%）。共有 33 例心脏死亡（2.5%）、42 例非致命性心肌梗死（3.7%）、50 例非致命性中风（4.9%）和 36 例计划外血运重建（3.2%）。睡眠呼吸暂停组的 MACCE 发生率高于非睡眠呼吸暂停组（2 年估计值，14.7%比 7.8%；p=0.002）。在未调整的 Cox 回归分析中，睡眠呼吸暂停预测了 MACCE 的发生（HR 1.69；95%CI 1.18 至 2.43），在调整年龄、性别、体重指数、左心室射血分数、糖尿病、高血压、慢性肾脏病和日间嗜睡后，这一关联仍具有统计学意义（调整后的 HR 1.57；95%CI 1.09 至 2.25）。
睡眠呼吸暂停与 CABG 患者的 MACCE 增加独立相关。
NCT02701504。
