Department of Cardiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China; Department of Cardiology, People's Liberation Army General Hospital, Beijing, China; The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
The Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
Chest. 2020 Nov;158(5):2146-2154. doi: 10.1016/j.chest.2020.05.615. Epub 2020 Jul 15.
The relation of snoring to risks of stroke and other major cardiovascular (CV) events is uncertain.
We aimed to determine associations of snoring patterns and major CV events in relation to OSA among participants of the international Sleep Apnea cardiovascular Endpoints (SAVE) trial.
Post hoc analyses of the SAVE trial, which involved 2,687 patients with coexisting moderate-to-severe OSA and established coronary or cerebral CV disease, who were randomly allocated to CPAP treatment plus usual care or usual care alone, and followed-up for a median 3.5 years. Associations of self-reported snoring patterns (frequency and loudness) and breathing pauses collected on the Berlin questionnaire at baseline and multiple times during follow-up, and adjudicated composites of CV outcomes (primary, CV death, nonfatal myocardial infarction, nonfatal stroke, and hospitalization for unstable angina, heart failure, or transient ischemic attack; and separately of cardiac and cerebral events), were evaluated in time-dependent Cox proportional hazards models adjusted for various confounders including the apnea-hypopnea index.
Increase (per category) of snoring frequency (adjusted hazard ratio [HR], 1.10; 95% CI, 1.02-1.20; P = .015), loudness (HR, 1.16; 95% CI, 1.06-1.27; P = .001), and breathing pauses (HR, 1.16; 95% CI, 1.08-1.25; P < .001) at any time point during follow-up were each associated with the primary composite CV outcome. These associations were driven by significant associations for cerebral rather than cardiac events, and positive interactions between the three snoring patterns for cerebral events. There was no significant interaction between CPAP treatment and snoring variables for cerebral events.
Snoring in patients with OSA with established CV disease is associated with greater risks of cerebral but not cardiac events, independent of CPAP treatment and frequency of apnea and hypopnea events.
ClinicalTrials.gov; No.: NCT00738179; URL: www.clinicaltrials.gov.
打鼾与中风和其他主要心血管（CV）事件的风险之间的关系尚不确定。
我们旨在确定国际睡眠呼吸暂停心血管终点（SAVE）试验中参与者的打鼾模式与 OSA 相关的主要 CV 事件之间的关联。
对 SAVE 试验进行了事后分析，该试验涉及 2687 名同时患有中度至重度 OSA 和已确诊的冠状动脉或脑心血管疾病的患者，他们被随机分配接受 CPAP 治疗加常规护理或单独常规护理，并随访中位数为 3.5 年。使用基线和随访期间多次收集的柏林问卷报告的打鼾模式（频率和响度）和呼吸暂停，以及 CV 结局综合指标（主要结局为心血管死亡、非致死性心肌梗死、非致死性中风以及不稳定型心绞痛、心力衰竭或短暂性脑缺血发作的住院治疗；分别为心脏和大脑事件）的相关性，在时间依赖性 Cox 比例风险模型中进行评估，该模型调整了包括睡眠呼吸暂停低通气指数在内的各种混杂因素。
随访期间任何时间点的打鼾频率（调整后的危险比 [HR]，1.10；95%CI，1.02-1.20；P=.015）、响度（HR，1.16；95%CI，1.06-1.27；P=.001）和呼吸暂停（HR，1.16；95%CI，1.08-1.25；P<.001）的增加（每类）均与主要 CV 复合结局相关。这些关联主要归因于与大脑而非心脏事件的显著关联，以及三种打鼾模式之间的阳性相互作用。在大脑事件中，CPAP 治疗与打鼾变量之间没有显著的相互作用。
患有已确诊心血管疾病的 OSA 患者的打鼾与大脑但不是心脏事件的风险增加有关，独立于 CPAP 治疗和呼吸暂停和低通气事件的频率。
ClinicalTrials.gov；编号：NCT00738179；网址：www.clinicaltrials.gov。
