植入式除颤器计算的呼吸紊乱指数的预后价值：DASAP-HF 研究。
Prognostic value of implantable defibrillator-computed respiratory disturbance index: The DASAP-HF study.
机构信息
University of Modena and Reggio Emilia, Modena, Italy.
Vito Fazzi Hospital, Lecce, Italy.
出版信息
Heart Rhythm. 2021 Mar;18(3):374-381. doi: 10.1016/j.hrthm.2020.10.019. Epub 2020 Oct 24.
BACKGROUND
Sleep apnea, as measured by polysomnography, is associated with adverse outcomes in heart failure. The DASAP-HF (Diagnosis and Treatment of Sleep Apnea in Patient With Heart Failure) study previously demonstrated that the respiratory disturbance index (RDI) computed by the ApneaScan algorithm (Boston Scientific) accurately identifies severe sleep apnea in implantable cardioverter-defibrillator (ICD) patients.
OBJECTIVE
The purpose of the long-term study phase was to assess the incidence of clinical events after 24 months and investigate the association with RDI values.
METHODS
Patients with left ventricular ejection fraction ≤35% implanted with an ICD were enrolled and followed-up for 24 months. The RDI calculated at 1 month after implantation was used to stratify patients (below or above 30 episodes/h). The endpoints were all-cause death and a combination of all-cause death or cardiovascular hospitalization.
RESULTS
Of the 265 enrolled patients, 224 had usable RDI values. Severe sleep apnea (RDI ≥30 episodes/h) was diagnosed in 115 patients (51%). These patients were more frequently male (84% vs 72%; P = .030) and had higher creatinine levels. During median follow-up of 25 months, 19 patients (8%) died. Cardiovascular hospitalizations were reported in 19 patients (8%). The risk of all-cause death was higher in patients with RDI ≥30 episodes/h (hazard ratio [HR] 3.33; 95% confidence interval [CI] 1.35-8.21; P = .023), as well as the risk of all-cause death or cardiovascular hospitalization (HR 1.94; 95% CI 1.01-3.76; P = .048). At multivariate analysis, independent predictors of death were RDI ≥30 episodes/h (HR 4.02; 95% CI 1.16-13.97; P = .029) and creatinine levels (HR 2.36; 95% CI 1.26-4.42; P = .008).
CONCLUSION
In heart failure patients implanted with an ICD, higher RDI values are associated with death and cardiovascular hospitalizations. Device-detected severe sleep apnea independently predicts death.
背景
多导睡眠图测量的睡眠呼吸暂停与心力衰竭的不良结局相关。先前的 DASAP-HF（心力衰竭患者睡眠呼吸暂停的诊断和治疗）研究表明，Boston Scientific 公司的 ApneaScan 算法计算的呼吸紊乱指数（RDI）可准确识别植入式心脏复律除颤器（ICD）患者的严重睡眠呼吸暂停。
目的
长期研究阶段的目的是评估 24 个月后的临床事件发生率，并研究与 RDI 值的关联。
方法
纳入左心室射血分数≤35%植入 ICD 的患者，并随访 24 个月。将植入后 1 个月计算的 RDI 用于分层患者（低于或高于 30 次/小时）。终点为全因死亡和全因死亡或心血管住院的组合。
结果
在 265 名入组患者中，有 224 名患者的 RDI 值可用。诊断 115 名患者（51%）存在严重睡眠呼吸暂停（RDI≥30 次/小时）。这些患者更常为男性（84%比 72%；P=.030），且肌酐水平更高。在中位随访 25 个月期间，有 19 名患者（8%）死亡。19 名患者（8%）报告发生心血管住院。RDI≥30 次/小时的患者全因死亡风险更高（风险比[HR]3.33；95%置信区间[CI]1.35-8.21；P=.023），全因死亡或心血管住院的风险也更高（HR 1.94；95% CI 1.01-3.76；P=.048）。多变量分析显示，死亡的独立预测因素为 RDI≥30 次/小时（HR 4.02；95% CI 1.16-13.97；P=.029）和肌酐水平（HR 2.36；95% CI 1.26-4.42；P=.008）。
结论
在植入 ICD 的心力衰竭患者中，较高的 RDI 值与死亡和心血管住院相关。设备检测到的严重睡眠呼吸暂停独立预测死亡。
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