Istituti Clinici Scientifici Maugeri IRCCS, Institute of Bari Italy.
Istituti Clinici Scientifici Maugeri IRCCS, Institute of Bari Italy.
Eur J Intern Med. 2021 Aug;90:71-76. doi: 10.1016/j.ejim.2021.04.018. Epub 2021 May 9.
Obstructive sleep apnoea syndrome (OSAS) is a highly prevalent disorder. The prognostic role of comorbidity in patients with OSAS and their role for risk stratification remain poorly defined.
We studied 1,592 patients with severe OSAS diagnosed by polysomnography. The primary outcome was all-cause mortality. The standardized mortality ratio (SMR) was estimated as the ratio of observed deaths to expected number of deaths in the general population. The expected numbers of deaths were derived using mortality rates from the general Apulian population. The association of comorbidities with all-cause mortality was assessed using multivariable Cox regression analysis. Finally, recursive-partitioning analysis was applied to identify the combinations of comorbidities that were most influential for mortality and to cluster the patients into risk groups according to individual comorbidities RESULTS: During 11,721 person-years of follow-up, 390 deaths (3.33 deaths/100 person-years) occurred. The median follow-up was 7 (4-10) years. The SMR was 1.47 (95% confidence intervals 1.33-1.63). Age, sex, obesity, cardiovascular diseases (CVD), moderate-to-severe chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD) and malignancy were independently associated with mortality risk. Recursive-partitioning analysis allowed distinguishing three clinical phenotypes differentially associated with mortality risk. The combination of CKD with CVDs or with moderate-to-severe COPD conferred the highest risk.
Severe OSAS is associated with increased risk for all-cause death. Age and comorbidity are crucial predictors of mortality in patients with severe OSAS. Clustering patients according to comorbidities allows identifying clinically meaningful phenotypes.
阻塞性睡眠呼吸暂停综合征（OSAS）是一种高发疾病。合并症在 OSAS 患者中的预后作用及其在风险分层中的作用仍未得到明确界定。
我们研究了 1592 例经多导睡眠图诊断为重度 OSAS 的患者。主要结局是全因死亡率。标准化死亡率比（SMR）定义为观察到的死亡人数与普通人群预期死亡人数的比值。预期死亡人数来源于普通阿普利亚人群的死亡率。使用多变量 Cox 回归分析评估合并症与全因死亡率的关系。最后，采用递归分区分析确定对死亡率影响最大的合并症组合，并根据个体合并症将患者聚类为风险组。
在 11721 人年的随访期间，发生了 390 例死亡（3.33 例/100 人年）。中位随访时间为 7（4-10）年。SMR 为 1.47（95%置信区间 1.33-1.63）。年龄、性别、肥胖、心血管疾病（CVD）、中重度慢性阻塞性肺疾病（COPD）、慢性肾脏病（CKD）和恶性肿瘤与死亡风险独立相关。递归分区分析允许区分与死亡率风险相关的三种不同的临床表型。CKD 与 CVD 或与中重度 COPD 的组合具有最高的风险。
重度 OSAS 与全因死亡风险增加相关。年龄和合并症是重度 OSAS 患者死亡的重要预测因素。根据合并症对患者进行聚类可识别具有临床意义的表型。
