持续气道正压通气对日本阻塞性睡眠呼吸暂停患者的生存获益：倾向评分匹配分析。
Survival benefit of continuous positive airway pressure in Japanese patients with obstructive sleep apnea: a propensity-score matching analysis.
机构信息
Urasoe General Hospital, Okinawa, Japan.
Nakamura Clinic, Urasoe, Okinawa, Japan.
出版信息
J Clin Sleep Med. 2021 Feb 1;17(2):211-218. doi: 10.5664/jcsm.8842.
STUDY OBJECTIVES
Continuous positive airway pressure (CPAP) improves quality of life in patients with obstructive sleep apneas. However, the long-term benefit in all-cause mortality and cardiovascular death are limited among Japanese.
METHODS
We conducted a retrospective study of patients treated in our sleep clinic in Okinawa, Japan. All patients with full-scale polysomnography from September 1990 to December 2010 were investigated in terms of outcomes such as death (dates and causes of death) between 2012 and 2013 by chart review, telephone calls, and letters of inquiry. Propensity-score matching was performed to balance baseline characteristic differences between a CPAP user group and a nonuser group. The primary outcomes were all-cause mortality and a composite of cardiovascular disease mortality, such as heart disease and stroke, between the two groups.
RESULTS
The CPAP user group, almost double in number, had more severe obstructive sleep apnea, more comorbidities, smoking, and alcohol consumption compared to the nonuser group but no significant difference in Epworth Sleepiness Scale. Propensity-score matching selected 1,274 of 4,519 patients as the CPAP user group and 1,274 of 2,128 as the CPAP nonuser group. Mean age of the patients was 52.3 (±13.5) years and 79% were men. After a median follow-up of 79 (interquartile interval, 24 to 128) months in the CPAP user group and 73.5 (interquartile interval, 26 to 111) in the non-CPAP group, death from all causes occurred in 53 (4.2%) patients in CPAP user group and in 94 (7.4%) patients in CPAP nonuser group. The leading cause of death was malignancy in each group. The hazard ratios for all-cause mortality and cardiovascular disease deaths were 0.56 (95% confidence interval (CI), 0.41-0.78) and 0.54 (95% CI, 0.28-1.03) between CPAP user group and CPAP nonuser group, respectively.
CONCLUSIONS
In obstructive sleep apnea patients, CPAP use was associated with lower all-cause mortality.
研究目的
持续气道正压通气（CPAP）可改善阻塞性睡眠呼吸暂停患者的生活质量。然而，CPAP 在日本的全因死亡率和心血管死亡方面的长期获益有限。
方法
我们对在日本冲绳的睡眠诊所接受治疗的患者进行了回顾性研究。通过病历回顾、电话和查询信件，调查了 1990 年 9 月至 2010 年 12 月期间所有接受全面多导睡眠图检查的患者在 2012 年至 2013 年期间的结局，如死亡（日期和死因）。通过倾向评分匹配来平衡 CPAP 使用组和非使用组之间的基线特征差异。主要结局是两组之间的全因死亡率和心血管疾病死亡率（如心脏病和中风）的复合结局。
结果
CPAP 使用组的人数几乎翻了一番，与非使用组相比，CPAP 使用组患者的阻塞性睡眠呼吸暂停更严重、合并症更多、吸烟和饮酒更多，但 Epworth 嗜睡量表无显著差异。倾向评分匹配选择了 4519 例患者中的 1274 例作为 CPAP 使用组，2128 例患者中的 1274 例作为 CPAP 非使用组。患者的平均年龄为 52.3（±13.5）岁，79%为男性。CPAP 使用组的中位随访时间为 79（四分位间距，24 至 128）个月，CPAP 非使用组为 73.5（四分位间距，26 至 111）个月，CPAP 使用组中有 53 例（4.2%）患者死于各种原因，CPAP 非使用组中有 94 例（7.4%）患者死于各种原因。两组的主要死亡原因均为恶性肿瘤。CPAP 使用组与 CPAP 非使用组的全因死亡率和心血管疾病死亡率的风险比分别为 0.56（95%置信区间（CI），0.41-0.78）和 0.54（95% CI，0.28-1.03）。
结论
在阻塞性睡眠呼吸暂停患者中，CPAP 的使用与全因死亡率降低相关。
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