心房颤动患者的体位性阻塞性睡眠呼吸暂停。
Positional obstructive sleep apnea in patients with atrial fibrillation.
机构信息
Department of Medicine, University of Virginia, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908, USA.
Department of Medicine, Cleveland Clinic, Cleveland, OH, USA.
出版信息
Sleep Breath. 2023 May;27(2):487-494. doi: 10.1007/s11325-022-02625-y. Epub 2022 May 10.
PURPOSE
Obstructive sleep apnea (OSA) is a common, potentially modifiable condition implicated in the pathogenesis of atrial fibrillation (AF). The presence and severity of OSA is largely sleep position-dependent, yet there is high variability in positional dependence among patients with OSA. We investigated the prevalence of positional OSA (POSA) and examined associated factors in patients with AF.
METHODS
We recruited an equal number of patients with and without AF who underwent diagnostic polysomnography. Patients included had ≥ 120 min of total sleep time with 30 min of sleep in both supine and lateral positions. POSA was defined as an overall apnea hypopnea index (AHI) ≥ 5/h, supine AHI (sAHI) ≥ 5/h, and sAHI greater than twice the non-supine AHI. POSA prevalence was compared in patients with and without AF adjusting for age, sex, OSA severity, and heart failure.
RESULTS
A total of patients (male: 56%, mean age 62 years) were included. POSA prevalence was similar between the two groups (46% vs. 39%; p = 0.33). Obesity and severe OSA (AHI ≥ 30/h) were associated with low likelihood of POSA (OR [CI] of 0.17 [0.09-0.32] and 0.28 [0.12-0.62]). In patients with AF, male sex was associated with a higher likelihood of POSA (OR [CI] of 3.16 [1.06-10.4]).
CONCLUSION
POSA is common, affecting more than half of patients with AF, but the prevalence was similar in those without AF. Obesity and more severe OSA are associated with lower odds of POSA. Positional therapy should be considered in patients with mild OSA and POSA.
目的
阻塞性睡眠呼吸暂停（OSA）是一种常见的、潜在可改变的疾病，与心房颤动（AF）的发病机制有关。OSA 的存在和严重程度在很大程度上取决于睡眠姿势，但 OSA 患者的体位依赖性差异很大。我们调查了 AF 患者中体位性 OSA（POSA）的患病率，并研究了相关因素。
方法
我们招募了数量相等的有和没有 AF 的患者进行诊断性多导睡眠图检查。纳入的患者有≥120 分钟的总睡眠时间，仰卧位和侧卧位各有 30 分钟睡眠。POSA 的定义为总睡眠呼吸暂停低通气指数（AHI）≥5/h、仰卧位 AHI（sAHI）≥5/h 且 sAHI 大于非仰卧位 AHI 的两倍。调整年龄、性别、OSA 严重程度和心力衰竭后，比较 AF 患者和无 AF 患者的 POSA 患病率。
结果
共纳入了例患者（男性：56%，平均年龄 62 岁）。两组的 POSA 患病率相似（46%比 39%；p=0.33）。肥胖和重度 OSA（AHI≥30/h）与 POSA 的低可能性相关（OR[CI]为 0.17[0.09-0.32]和 0.28[0.12-0.62]）。在 AF 患者中，男性与 POSA 的可能性较高相关（OR[CI]为 3.16[1.06-10.4]）。
结论
POSA 很常见，影响超过一半的 AF 患者，但在无 AF 的患者中患病率相似。肥胖和更严重的 OSA 与 POSA 的可能性较低相关。对于轻度 OSA 和 POSA 患者，应考虑体位治疗。
Zotero 插件