Respiratory and Critical Care Department, Third Affiliated Hospital of Soochow University, First People's Hospital of Changzhou, Changzhou, China.
Department of Tumor Biological Treatment, Third Affiliated Hospital of Soochow University, First People's Hospital of Changzhou, Changzhou, China.
J Sleep Res. 2023 Aug;32(4):e13828. doi: 10.1111/jsr.13828. Epub 2023 Feb 2.
The aim of this study is to explore the association between depression and obstructive sleep apnea, and cardiovascular disease morbidity/all-cause mortality using Sleep Heart Health Study data. This post hoc analysis of a prospective study used patient data from the Sleep Heart Health Study conducted between 1995 and 1998. The association between depression and obstructive sleep apnea, and cardiovascular disease morbidity/all-cause mortality was explored using multivariable Cox proportional hazard models. A total of 4918 participants, 656 (13.3%) with obstructive sleep apnea (obstructive sleep apnea group), 1614 (32.8%) with depression (depression group), 482 (9.8%) with depression and obstructive sleep apnea (depression and obstructive sleep apnea group), and 2166 (44%) with neither obstructive sleep apnea nor depression (health group), were included. The incidence of cardiovascular disease was 24.5%, 31.0%, 31.6% and 41.7% for healthy, depression, obstructive sleep apnea, and depression and obstructive sleep apnea groups, respectively. The risk of cardiovascular disease in depression and obstructive sleep apnea participants was increased compared with that in healthy participants, which was consistent across various definitions of obstructive sleep apnea (hazard ratio [95% confidence interval]: 1.24 [1.06-1.47]; 1.25 [1.05-1.49]; 1.28 [1.06-1.54]; 1.55 [1.22-1.96] for apnea-hypopnea index ≥ 10 per hr, 15 per hr, 20 per hr, 30 per hr, respectively). The risk of all-cause mortality was increased in the depression and obstructive sleep apnea participants (hazard ratio: 1.46; 95% confidence interval: 1.07-1.99) compared with that in healthy participants when the definition of obstructive sleep apnea was apnea-hypopnea index ≥ 30. Participants with depression and obstructive sleep apnea might be at a greater risk of cardiovascular disease, and those with higher apnea-hypopnea index might be at a greater risk of all-cause mortality.
本研究旨在利用睡眠心脏健康研究的数据，探讨抑郁与阻塞性睡眠呼吸暂停及心血管疾病发病率/全因死亡率之间的关系。这项前瞻性研究的事后分析使用了 1995 年至 1998 年进行的睡眠心脏健康研究中的患者数据。使用多变量 Cox 比例风险模型探讨了抑郁与阻塞性睡眠呼吸暂停及心血管疾病发病率/全因死亡率之间的关系。共纳入 4918 名参与者，其中 656 名（13.3%）患有阻塞性睡眠呼吸暂停（阻塞性睡眠呼吸暂停组），1614 名（32.8%）患有抑郁（抑郁组），482 名（9.8%）患有抑郁和阻塞性睡眠呼吸暂停（抑郁和阻塞性睡眠呼吸暂停组），2166 名（44%）既无阻塞性睡眠呼吸暂停也无抑郁（健康组）。健康、抑郁、阻塞性睡眠呼吸暂停和抑郁和阻塞性睡眠呼吸暂停组的心血管疾病发生率分别为 24.5%、31.0%、31.6%和 41.7%。与健康参与者相比，抑郁和阻塞性睡眠呼吸暂停组参与者的心血管疾病风险增加，这在各种阻塞性睡眠呼吸暂停定义中都是一致的（风险比[95%置信区间]：1.24[1.06-1.47]；1.25[1.05-1.49]；1.28[1.06-1.54]；1.55[1.22-1.96]，呼吸暂停低通气指数≥10 次/小时、15 次/小时、20 次/小时、30 次/小时）。与健康参与者相比，当阻塞性睡眠呼吸暂停的定义为呼吸暂停低通气指数≥30 时，抑郁和阻塞性睡眠呼吸暂停组参与者的全因死亡率风险增加（风险比：1.46；95%置信区间：1.07-1.99）。患有抑郁和阻塞性睡眠呼吸暂停的参与者可能面临更大的心血管疾病风险，而呼吸暂停低通气指数较高的参与者可能面临更大的全因死亡率风险。
