From the, Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden.
Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
J Intern Med. 2021 Aug;290(2):392-403. doi: 10.1111/joim.13294. Epub 2021 May 10.
Sleep-related breathing disorders (SRBDs), particularly obstructive sleep apnoea, are associated with increased cardiovascular (CV) risk. However, it is not known whether individual questions used for SRBD screening are associated with major adverse CV events (MACE) and death specifically in patients with chronic coronary syndrome (CCS).
Symptoms associated with SRBD were assessed by a baseline questionnaire in 15,640 patients with CCS on optimal secondary preventive therapy in the STABILITY trial. The patients reported the frequency (never/rarely, sometimes, often and always) of: 1) loud snoring; 2) more than one awakening/night; 3) morning tiredness (MT); 4) excessive daytime sleepiness (EDS); or 5) gasping, choking or apnoea when asleep. In adjusted Cox regression models, associations between the frequency of SRBD symptoms and CV outcomes were assessed with never/rarely as reference.
During a median follow-up time of 3.7 years, 1,588 MACE events (541 CV deaths, 749 nonfatal myocardial infarctions [MI] and 298 nonfatal strokes) occurred. EDS was associated (hazard ratio [HR], 95% confidence interval [CI]) with increased risk of MACE (sometimes 1.14 [1.01-1.29], often 1.19 [1.01-1.40] and always 1.43 [1.15-1.78]), MI (always 1.61 [1.17-2.20]) and all-cause death (often 1.26 [1.05-1.52] and always 1.71 [1.35-2.15]). MT was associated with higher risk of MACE (often 1.23 [1.04-1.45] and always 1.46 [1.18-1.81]), MI (always 1.61 [1.22-2.14]) and all-cause death (always 1.54 [1.20-1.98]). The other SRBD-related questions were not consistently associated with worse outcomes.
In patients with CCS, gradually higher levels of EDS and MT were independently associated with increased risk of MACE, including mortality.
睡眠相关呼吸障碍（SRBD），特别是阻塞性睡眠呼吸暂停，与心血管（CV）风险增加有关。然而，目前尚不清楚用于 SRBD 筛查的个别问题是否与慢性冠状动脉综合征（CCS）患者的主要不良心血管事件（MACE）和死亡有特定关联。
在 STABILITY 试验中，对接受最佳二级预防治疗的 15640 例 CCS 患者在基线时通过问卷评估与 SRBD 相关的症状。患者报告以下症状的发生频率（从不/很少、有时、经常和总是）：1）大声打鼾；2）每晚醒来/醒来超过一次；3）清晨疲倦（MT）；4）白天过度嗜睡（EDS）；或 5）睡觉时喘息、窒息或呼吸暂停。在调整后的 Cox 回归模型中，以从不/很少作为参考，评估 SRBD 症状频率与 CV 结局之间的关联。
在中位随访 3.7 年期间，发生了 1588 例 MACE 事件（541 例 CV 死亡、749 例非致命性心肌梗死[MI]和 298 例非致命性卒中）。EDS 与 MACE（有时 1.14 [1.01-1.29]、经常 1.19 [1.01-1.40]和总是 1.43 [1.15-1.78]）、MI（总是 1.61 [1.17-2.20]）和全因死亡（经常 1.26 [1.05-1.52]和总是 1.71 [1.35-2.15]）的风险增加相关。MT 与 MACE（经常 1.23 [1.04-1.45]和总是 1.46 [1.18-1.81]）、MI（总是 1.61 [1.22-2.14]）和全因死亡（总是 1.54 [1.20-1.98]）的风险增加相关。其他与 SRBD 相关的问题与较差的结局没有一致的关联。
在 CCS 患者中，逐渐升高的 EDS 和 MT 水平与 MACE 风险增加相关，包括死亡率。
