Respiratory Department, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain.
Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Outcomes Research and Evaluation (CORE), Yale University School of Medicine, New Haven, CT, USA; Cardiovascular Research Foundation, New York, USA.
Thromb Res. 2022 Jun;214:87-92. doi: 10.1016/j.thromres.2022.04.017. Epub 2022 May 1.
There is a paucity of data examining the prognostic significance of untreated obstructive sleep apnea (OSA) in hemodynamically stable patients with acute pulmonary embolism (PE). This prospective cohort study enrolled consecutive non-hypotensive patients with acute PE who underwent an overnight sleep study within 48 h after diagnosis. The patients were divided into 2 groups based on apnea-hypopnea index (AHI): OSA (AHI ≥15) and non-OSA (AHI <15) groups. The study used a composite of fatal or nonfatal cardiovascular events, including PE-related death, other cardiovascular deaths, clinical deterioration requiring an escalation of treatment, recurrent venous thromboembolism, acute myocardial infarction, or stroke within 30-days after the diagnosis of PE as the primary outcome. Between January 1, 2018, and December 31, 2020, 283 eligible patients were prospectively enrolled in 2 academic hospitals, of whom 268 patients completed a sleep study within 7 days of PE diagnosis. OSA was found in 47% (95% confidence interval [CI], 41 to 54%) of patients. The primary outcome occurred in 13 (4.9%) patients within 30-days after the diagnosis of PE. The crude incidence of the composite was not significantly different in the OSA than the non-OSA group (30-day estimate, 6.3% versus 3.5%; P = 0.30). OSA did not significantly predict the incidence of the primary outcome after adjustment for age, sex, body mass index, systolic blood pressure, heart rate, and oxygen saturation (adjusted hazard ratio, 2.15; 95% confidence interval, 0.67-6.87). In this study, untreated OSA was not a significant multivariable predictor of adverse cardiovascular events in patients with acute PE.
目前，关于未经治疗的阻塞性睡眠呼吸暂停（OSA）在血流动力学稳定的急性肺栓塞（PE）患者中的预后意义的数据较少。这项前瞻性队列研究纳入了连续的非低血压急性 PE 患者，这些患者在诊断后 48 小时内接受了夜间睡眠研究。根据呼吸暂停低通气指数（AHI）将患者分为 2 组：OSA（AHI≥15）组和非 OSA（AHI＜15）组。该研究将 30 天内发生的致命或非致命心血管事件（包括与 PE 相关的死亡、其他心血管死亡、需要升级治疗的临床恶化、复发性静脉血栓栓塞、急性心肌梗死或中风）作为主要结局，复合终点事件。2018 年 1 月 1 日至 2020 年 12 月 31 日，2 家学术医院前瞻性纳入了 283 名符合条件的患者，其中 268 名患者在 PE 诊断后 7 天内完成了睡眠研究。47%（95%置信区间[CI]，41 至 54%）的患者存在 OSA。PE 诊断后 30 天内，主要结局事件发生在 13 名（4.9%）患者中。OSA 组与非 OSA 组的复合终点发生率无显著差异（30 天估计值，6.3%与 3.5%；P=0.30）。在校正年龄、性别、体重指数、收缩压、心率和血氧饱和度后，OSA 并不能显著预测主要结局的发生（校正后的危险比，2.15；95%置信区间，0.67-6.87）。在这项研究中，未经治疗的 OSA 并不是急性 PE 患者不良心血管事件的显著多变量预测因素。
