睡眠呼吸暂停、冠状动脉钙密度与心血管事件：来自动脉粥样硬化多民族研究的结果。
Sleep apnea, coronary artery calcium density, and cardiovascular events: results from the Multi-Ethnic Study of Atherosclerosis.
机构信息
Montefiore Medical Center, Bronx, New York.
Icahn School of Medicine at Mount Sinai, New York, New York.
出版信息
J Clin Sleep Med. 2021 Oct 1;17(10):2075-2083. doi: 10.5664/jcsm.9356. Epub 2021 May 14.
STUDY OBJECTIVES
Evaluate the association between obstructive sleep apnea (OSA), coronary artery calcium (CAC) density, and cardiovascular events in the Multi-Ethnic Study of Atherosclerosis (MESA).
METHODS
We analyzed 1,041 participants with nonzero CAC scores who had polysomnography and CAC density data from the fifth examination of the Multi-Ethnic Study of Atherosclerosis. OSA was defined as apnea-hypopnea index ≥ 15 events/h. Multivariable linear regression models were used to evaluate the independent association between OSA and CAC density. Additionally, we evaluated the impact of OSA on associations of CAC measures with incident cardiovascular disease events by testing for interaction in Cox proportional hazard regression models.
RESULTS
Our analytical sample was 45% female with a mean age of 70.6 +/- 9 years. Of this sample, 36.7% (n = 383/1041) had OSA (apnea-hypopnea index ≥ 15 events/h). OSA was inversely and weakly associated with CAC density β = -0.09; 95% CI, -0.17 to -0.02; = .014 and remained significantly associated after controlling for traditional cardiovascular risk factors (β = -0.08; 95% CI, -0.16 to 0; = .043). However, this inverse association was attenuated after controlling for body mass index (β = -0.05; 95% CI, -0.13 to 0.02; = .174). The mean follow-up period for cardiovascular disease events was 13.3 +/- 2.8 years. Additionally, exploratory analysis demonstrated that CAC density was independently and inversely associated with cardiovascular disease events only in the non-OSA subgroup (apnea-hypopnea index ≤ 15 events/h) (hazard ratio, 0.509; 95% CI, 0.323-0.801); = .0035).
CONCLUSIONS
OSA was associated with lower CAC density, but this association was attenuated by body mass index. Further, increased CAC density was associated with a reduced risk of cardiovascular disease events only in individuals within the non-OSA group in exploratory analysis.
CITATION
Newman SB, Kundel V, Matsuzaki M, et al. Sleep apnea, coronary artery calcium density, and cardiovascular events: results from the Multi-Ethnic Study of Atherosclerosis. . 2021;17(10):2075-2083.
研究目的
评估阻塞性睡眠呼吸暂停（OSA）、冠状动脉钙（CAC）密度与心血管事件在动脉粥样硬化多民族研究（MESA）中的相关性。
方法
我们分析了第五次 MESA 检查中同时具有非零 CAC 评分和多导睡眠图及 CAC 密度数据的 1041 名参与者。OSA 定义为呼吸暂停低通气指数≥15 次/小时。采用多变量线性回归模型评估 OSA 与 CAC 密度之间的独立相关性。此外，我们通过 Cox 比例风险回归模型中的交互检验来评估 OSA 对 CAC 指标与心血管疾病事件发生之间关联的影响。
结果
我们的分析样本中女性占 45%，平均年龄为 70.6±9 岁。该样本中，36.7%（n=383/1041）患有 OSA（呼吸暂停低通气指数≥15 次/小时）。OSA 与 CAC 密度呈负相关且相关性较弱（β=-0.09；95%CI，-0.17 至-0.02；P=0.014），且在控制传统心血管危险因素后仍具有显著相关性（β=-0.08；95%CI，-0.16 至 0；P=0.043）。然而，在控制体重指数后，这种负相关关系减弱（β=-0.05；95%CI，-0.13 至 0.02；P=0.174）。心血管疾病事件的平均随访时间为 13.3±2.8 年。此外，探索性分析表明，仅在非 OSA 亚组（呼吸暂停低通气指数≤15 次/小时）中，CAC 密度与心血管疾病事件呈独立且负相关（危险比，0.509；95%CI，0.323 至 0.801；P=0.0035）。
结论
OSA 与 CAC 密度较低有关，但这种相关性在控制体重指数后减弱。此外，在探索性分析中，仅在非 OSA 组中，CAC 密度增加与心血管疾病事件风险降低相关。
引文
Newman SB, Kundel V, Matsuzaki M, et al. Sleep apnea, coronary artery calcium density, and cardiovascular events: results from the Multi-Ethnic Study of Atherosclerosis.. 2021;17(10):2075-2083.
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