Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Centro de Enfermedades Respiratorias y Grupo de Estudio Trastornos Respiratorios del Sueño (GETRS), Clínica Las Condes, Santiago, Chile.
Chest. 2021 Dec;160(6):2266-2274. doi: 10.1016/j.chest.2021.06.047. Epub 2021 Jul 2.
Previous studies reported a strong association between sleepiness-related symptoms and comorbidities with poor cardiovascular outcomes among patients with moderate to severe OSA (msOSA). However, the validation of these associations in the Hispanic population from South America and the ability to predict incident cardiovascular disease remain unclear.
In Hispanic patients with msOSA, are four different cluster analyses reproducible and able to predict incident cardiovascular mortality?
Using the SantOSA cohort, we reproduced four cluster analyses (Sleep Heart Health Study [SHHS], Icelandic Sleep Apnea Cohort [ISAC], Sleep Apnea Cardiovascular Endpoints [SAVE], and The Institute de Recherche en Sante Respiratoire des Pays de la Loire [IRSR] cohorts) following a cluster analysis similar to each training dataset. The incidence of cardiovascular mortality was constructed using a Kaplan-Meier (log-rank) model, and Cox proportional hazards models were adjusted by confounders.
Among 780 patients with msOSA in our cohort, two previous cluster analyses (SHHS and ISAC) were reproducible. The SAVE and IRSR cluster analyses were not reproducible in our sample. We identified the following subtypes for SHHS: "minimally symptomatic," "disturbed sleep," "moderate sleepiness," and "severe sleepiness." For ISAC, three different subtypes ("minimally symptomatic," "disturbed sleep," and "excessive sleepiness") were similar to the original dataset. Compared with "minimally symptomatic," we found a significant association between "excessive sleepiness" and cardiovascular mortality after 5 years of follow-up in SantOSA, hazard ratio (HR), 5.47; 95% CI, 1.74-8.29; P < .01; and HR, 3.23; 95% CI, 1.21-8.63; P = .02, using the SHHS and ISAC cluster analyses, respectively.
Among patients with msOSA, a symptom-based approach can validate different OSA patient subtypes, and those with excessive sleepiness have an increased risk of incident cardiovascular mortality in the Hispanic population from South America.
先前的研究报告称，在中重度阻塞性睡眠呼吸暂停（msOSA）患者中，与嗜睡相关的症状与合并症之间存在很强的关联，且这些合并症与较差的心血管结局相关。然而，这些关联在来自南美的西班牙裔人群中的验证情况以及预测心血管疾病事件的能力仍不清楚。
在患有 msOSA 的西班牙裔患者中，四种不同的聚类分析是否具有重现性，并能够预测心血管死亡事件的发生？
使用 SantOSA 队列，我们对四种聚类分析（睡眠心脏健康研究 [SHHS]、冰岛睡眠呼吸暂停队列 [ISAC]、睡眠呼吸暂停心血管终点研究 [SAVE]和法国卢瓦尔河地区呼吸研究所 [IRSR]队列）进行了重现，方法是对每个训练数据集进行类似的聚类分析。使用 Kaplan-Meier（对数秩）模型构建心血管死亡事件的发生率，并通过混杂因素调整 Cox 比例风险模型。
在我们的队列中，780 例 msOSA 患者中，有两项先前的聚类分析（SHHS 和 ISAC）具有重现性。SAVE 和 IRSR 聚类分析在我们的样本中不可重现。我们确定了 SHHS 的以下亚型：“轻度症状”、“睡眠紊乱”、“中度嗜睡”和“重度嗜睡”。对于 ISAC，三种不同的亚型（“轻度症状”、“睡眠紊乱”和“过度嗜睡”）与原始数据集相似。与“轻度症状”相比，我们在 SantOSA 随访 5 年后发现“过度嗜睡”与心血管死亡事件之间存在显著关联，风险比（HR）为 5.47；95%置信区间（CI）为 1.74-8.29；P<.01；并且使用 SHHS 和 ISAC 聚类分析，HR 分别为 3.23；95%CI 为 1.21-8.63；P=.02。
在患有 msOSA 的患者中，基于症状的方法可以验证不同的 OSA 患者亚型，而那些过度嗜睡的患者在来自南美的西班牙裔人群中发生心血管死亡事件的风险增加。
