Gill Jashan, Wu Chunyi
Department of Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
Department of Medicine, Northwestern Medicine McHenry Hospital, McHenry, IL, USA.
J Innov Card Rhythm Manag. 2022 Jun 15;13(6):5033-5040. doi: 10.19102/icrm.2022.130602. eCollection 2022 Jun.
Patients with obstructive sleep apnea (OSA) have an increased risk for arrhythmias compared to patients without OSA. However, data quantifying the risk of inpatient complications in patients with heart failure with preserved ejection fraction (HFpEF) are lacking. We sought to compare inpatient outcomes and the occurrence of arrhythmias in patients with HFpEF with and without OSA, respectively. Furthermore, we compared the prevalence of arrhythmias with nocturnal continuous positive airway pressure (CPAP) therapy. We performed a retrospective study using the National Inpatient Sample from 2016-2018 to identify patients with HFpEF with and without OSA. Propensity score matching, adjusting for age, gender, race, hospital characteristics, income, and comorbidities, was used to select matched samples between both groups. From 2016-2018, 127,773 hospitalizations with HFpEF were identified; among these patients, 20% had OSA. Nocturnal CPAP was utilized in 9% of these patients. Patients with OSA had a higher mortality rate, a longer duration of hospitalization, and greater medical costs. In addition, OSA was associated with higher incidence rates of atrial fibrillation, atrial flutter, premature depolarization, sick sinus syndrome, ventricular tachycardia, and atrioventricular block. Nocturnal CPAP was not associated with a lower arrhythmia incidence; however, there was a non-significant trend toward a lower cardiac arrest incidence. In conclusion, OSA in patients with HFpEF was associated with greater mortality, longer hospitalization stays, and higher medical costs relative to findings in patients without OSA. Furthermore, OSA was associated with tachyarrhythmias and bradyarrhythmias in HFpEF patients. Nocturnal CPAP was only utilized in 9% of patients, with no difference in arrhythmogenesis.
与无阻塞性睡眠呼吸暂停（OSA）的患者相比，患有OSA的患者发生心律失常的风险更高。然而，目前缺乏有关射血分数保留的心力衰竭（HFpEF）患者住院并发症风险的量化数据。我们试图分别比较有和没有OSA的HFpEF患者的住院结局和心律失常的发生情况。此外，我们比较了夜间持续气道正压通气（CPAP）治疗时心律失常的发生率。我们使用2016 - 2018年的全国住院患者样本进行了一项回顾性研究，以确定有和没有OSA的HFpEF患者。倾向评分匹配法用于调整年龄、性别、种族、医院特征、收入和合并症，以在两组之间选择匹配样本。2016 - 2018年期间，共识别出127,773例HFpEF住院患者；其中，20%的患者患有OSA。这些患者中有9%使用了夜间CPAP。患有OSA的患者死亡率更高、住院时间更长且医疗费用更高。此外，OSA与心房颤动、心房扑动、过早去极化、病态窦房结综合征、室性心动过速和房室传导阻滞的更高发病率相关。夜间CPAP与较低的心律失常发生率无关；然而，心脏骤停发生率有降低的趋势，但不显著。总之，与没有OSA的患者相比，HFpEF患者中的OSA与更高的死亡率、更长的住院时间和更高的医疗费用相关。此外，OSA与HFpEF患者的快速性心律失常和缓慢性心律失常有关。只有9%的患者使用了夜间CPAP，心律失常的发生没有差异。
