肥胖合并阻塞性睡眠呼吸暂停与单纯肥胖患者行减重手术后心房颤动和脑卒中的风险。

Risk of Atrial Fibrillation and Stroke After Bariatric Surgery in Patients With Morbid Obesity With or Without Obstructive Sleep Apnea.

机构信息

Aurora Cardiovascular and Thoracic Services, Advocate Aurora Health, Milwaukee, WI (A.D., M.S., Z.H., T.L.C., C.C., M.E.M., A.B., I.N., J.S., A.J.).

Center for Advanced Atrial Fibrillation Therapies, Advocate Aurora Health, Milwaukee, WI (T.L.C., C.C., M.E.M., A.B., I.N., J.S., A.J.).

出版信息

Stroke. 2021 Jul;52(7):2266-2274. doi: 10.1161/STROKEAHA.120.031920. Epub 2021 Apr 21.

DOI:10.1161/STROKEAHA.120.031920

PMID:33878894

Abstract

BACKGROUND AND PURPOSE

Weight loss in morbidly obese patients reduces atrial fibrillation (AF); however, it is unknown whether similar benefits are maintained in patients with obstructive sleep apnea (OSA). We sought to determine whether incident AF and stroke rates are affected by OSA after weight loss and to identify predictors of AF and stroke.

METHODS

Differences in laparoscopic adjustable gastric banding–induced weight loss on incident AF and stroke events in those with and without OSA in the entire and in propensity-matched cohorts were determined longitudinally, and independent predictors of AF and stroke were identified.

RESULTS

Of 827 morbidly obese patients who underwent laparoscopic adjustable gastric banding (mean age, 44±11 years; mean body mass index, 49±8 kg/m2), incident AF was documented in 4.96% and stroke in 5.44% of patients during a mean 6.0±3.2-year follow-up. Despite a similar reduction in body weight (19.6% and 21% in 3 years), new-onset AF was significantly higher in patients with OSA than without OSA in the entire (1.7% versus 0.5% per year; P<0.001) and propensity-matched cohorts. Incident stroke was higher in the OSA than in the non-OSA group (2.10% versus 0.47% per year; P<0.001), but only 20% of patients with stroke had documented AF. On multivariate analysis, OSA (hazard ratio, 2.88 [95% CI, 1.45–5.73]), age, and hypertension were independent predictors of new-onset AF, and OSA (hazard ratio, 5.84 [95% CI, 3.02–11.30]), depression, and body mass index were for stroke events.

CONCLUSIONS

In morbidly obese patients who underwent laparoscopic adjustable gastric banding, despite similar weight loss, patients with OSA had a higher incidence of AF and stroke than patients without OSA. Both non-AF and AF-related factors were involved in increasing stroke risk. Further investigation is warranted into whether OSA treatment helps reduce AF or stroke events in this population.

摘要

背景与目的

病态肥胖患者的体重减轻可降低心房颤动（AF）的发病率；然而，肥胖合并阻塞性睡眠呼吸暂停（OSA）患者的体重减轻是否具有相似的益处尚不清楚。我们旨在确定 OSA 患者在减肥后 AF 和中风的发生率是否受到影响，并确定 AF 和中风的预测因素。

方法

通过纵向研究，确定腹腔镜可调节胃束带术（LAGB）引起的肥胖患者在合并和不合并 OSA 患者中的体重减轻对 AF 和中风事件的影响，并确定 AF 和中风的独立预测因素。

结果

在 827 名接受腹腔镜可调节胃束带术（LAGB）治疗的病态肥胖患者中（平均年龄 44±11 岁；平均 BMI 49±8 kg/m2），平均 6.0±3.2 年的随访期间，有 4.96%的患者发生新发 AF，5.44%的患者发生中风。尽管体重减轻量相似（3 年内分别为 19.6%和 21%），但在整个队列和倾向匹配队列中，合并 OSA 的患者新发 AF 的发生率明显高于不合并 OSA 的患者（每年分别为 1.7%和 0.5%；P<0.001）。OSA 组的新发中风发生率高于非 OSA 组（每年分别为 2.10%和 0.47%；P<0.001），但仅有 20%的中风患者有记录的 AF。多变量分析显示，OSA（风险比，2.88 [95%可信区间，1.45–5.73]）、年龄和高血压是新发 AF 的独立预测因素，而 OSA（风险比，5.84 [95%可信区间，3.02–11.30]）、抑郁和 BMI 是中风事件的独立预测因素。