9·11 世界贸易中心恐怖袭击事件第一响应者中的阻塞性睡眠呼吸暂停和左心室舒张功能障碍：一项横断面研究。

Obstructive sleep apnoea and left ventricular diastolic dysfunction among first responders to the 9/11 World Trade Center terrorist attack: a cross-sectional study.

机构信息

Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, New York, USA

Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, New York, USA.

出版信息

BMJ Open. 2022 Apr 19;12(4):e058366. doi: 10.1136/bmjopen-2021-058366.

DOI:10.1136/bmjopen-2021-058366

PMID:35440460

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9020304/

Abstract

OBJECTIVES

Obstructive sleep apnoea (OSA) is often linked to cardiovascular disease. A limited number of studies have reported an association between OSA and left ventricular diastolic dysfunction (LVDD). However, prior studies were performed on small patient populations. Studies have shown a high prevalence of OSA among first responders to the 9/11 World Trade Center (WTC) terrorist attack. We investigated the relationship between OSA and LVDD in a large population of WTC responders.

DESIGN

Cross-sectional study.

SETTING

One-time screening programme as part of the WTC-CHEST Study (NCT10466218), performed at a quaternary medical centre in New York City, from November 2011 to June 2014.

PARTICIPANTS

A total of 1007 participants with mean age of 51 years of mostly non-Hispanic white men were evaluated. Patients from the WTC Health Program-Clinical Center of Excellence, who were over the age of 39 years, were eligible to participate.

RESULTS

Evaluation of those without OSA diagnosis showed no significant association with LVDD when comparing those screened (Berlin Questionnaire) as OSA high risk versus OSA low risk (p=0.101). Among those diagnosed with LVDD, there was a significant association when comparing those with and without patient-reported OSA (OR 1.50, 95% CI 1.13 to 2.00, p=0.005), but the significance was not maintained after adjusting for pertinent variables (OR 1.3, 0.94 to 1.75, p=0.119). Notably, comparing those with OSA diagnosis and those low risk of OSA, the OR for LVDD was significant (1.69, 1.24 to 2.31, p=0.001), and after adjusting for waist-hip ratio, diabetes and coronary artery calcium score percentile, the relationship remained significant (OR 1.45, 1.03 to 2.04, p=0.032).

CONCLUSION

The strong association of OSA with LVDD in this population may inform future guidelines to recommend screening for LVDD in high-risk asymptomatic patients with OSA.

摘要

目的

阻塞性睡眠呼吸暂停（OSA）常与心血管疾病相关。有少数研究报告了 OSA 与左心室舒张功能障碍（LVDD）之间的关联。然而，之前的研究都是针对小患者群体进行的。研究表明，在 9/11 世界贸易中心（WTC）恐怖袭击的第一批救援人员中，OSA 的患病率很高。我们在一个大型的 WTC 救援人员群体中调查了 OSA 与 LVDD 之间的关系。

设计

横断面研究。

地点

2011 年 11 月至 2014 年 6 月在纽约市一家四级医疗中心进行的 WTC-CHEST 研究（NCT10466218）中的一次性筛查项目。

参与者

共评估了 1007 名平均年龄为 51 岁的参与者，他们主要是非西班牙裔白人男性。年龄超过 39 岁的 WTC 健康计划-临床卓越中心的患者有资格参加。

结果

在比较那些经柏林问卷筛查为 OSA 高危与 OSA 低危的患者时，没有发现无 OSA 诊断与 LVDD 之间存在显著关联（p=0.101）。在那些被诊断为 LVDD 的患者中，比较有和无患者自述 OSA 的患者时，两者之间存在显著关联（OR 1.50，95%CI 1.13 至 2.00，p=0.005），但在调整了相关变量后，这种关联不再显著（OR 1.3，0.94 至 1.75，p=0.119）。值得注意的是，比较有 OSA 诊断和 OSA 低危风险的患者时，LVDD 的 OR 显著（1.69，1.24 至 2.31，p=0.001），在调整了腰围-臀围比、糖尿病和冠状动脉钙评分百分位数后，这种关系仍然显著（OR 1.45，1.03 至 2.04，p=0.032）。