肥胖状态下阻塞性睡眠呼吸暂停对急性冠状动脉综合征预后的影响。

Prognostic Implications of OSA in Acute Coronary Syndrome by Obesity Status.

机构信息

Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China.

National Clinical Research Center for Cardiovascular Diseases, Beijing, China; Arrhythmia Center, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

出版信息

Chest. 2023 Jul;164(1):219-230. doi: 10.1016/j.chest.2023.02.001. Epub 2023 Feb 9.

DOI:10.1016/j.chest.2023.02.001

PMID:36764513

Abstract

BACKGROUND

A close relationship exists between OSA and obesity. The impact of obesity on the prognostic significance of OSA in patients with acute coronary syndrome (ACS) remains unclear.

RESEARCH QUESTION

Do the effects of OSA on subsequent cardiovascular events in patients with ACS vary with obesity status?

STUDY DESIGN AND METHODS

This is a prospective cohort study. Patients 18 to 85 years of age who were hospitalized for ACS were consecutively enrolled and underwent portable sleep monitoring after clinical stabilization. OSA was defined as an apnea hypopnea index ≥ 15 events/h. The primary end point was major adverse cardiovascular and cerebrovascular event (MACCE), including cardiovascular death, hospitalization for ACS, stroke, ischemia-driven revascularization, or hospitalization for heart failure.

RESULTS

Among 1,920 patients enrolled (84.5% male; mean age ± SD, 56.4 ± 10.5 years), 1,013 (52.8%) had OSA, and 718 (37.4%) were obese (BMI ≥ 28 kg/m). During 2.9 years (1.5, 3.6 years) follow-up, the incidence of MACCE was significantly higher in patients with obesity than in patients without obesity (hazard ratio [HR], 1.29; 95% CI, 1.06-1.58; P = .013). Although the prevalence of OSA was lower in patients without obesity than in those with obesity (43.9% vs 67.5%; P < .001), OSA independently predicted the incidence of MACCE only in patients without obesity (adjusted HR, 1.34; 95% CI, 1.03-1.75; P = .03), but not in patients with obesity (adjusted HR, 1.10; 95% CI, 0.78-1.55; P = .58). No significant interaction between obesity and OSA was noted (P for interaction = .35). The incremental risk associated with OSA in patients without obesity might be explained by more hospitalization for ACS and ischemia-driven revascularization.

INTERPRETATION

For patients with ACS, OSA was independently associated with an increased risk of subsequent events, particularly among patients without obesity. These findings highlight the importance of identifying OSA in nonobese patients with ACS.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov; No.: NCT03362385; URL: www.

CLINICALTRIALS

gov.

摘要

背景

阻塞性睡眠呼吸暂停（OSA）与肥胖密切相关。肥胖对急性冠状动脉综合征（ACS）患者中 OSA 的预后意义的影响尚不清楚。

研究问题

OSA 对 ACS 患者后续心血管事件的影响是否因肥胖状态而异？

研究设计和方法

这是一项前瞻性队列研究。连续纳入因 ACS 住院的 18 至 85 岁患者，并在临床稳定后进行便携式睡眠监测。OSA 定义为呼吸暂停低通气指数≥15 次/小时。主要终点是主要不良心血管和脑血管事件（MACCE），包括心血管死亡、ACS 再住院、卒中和缺血驱动的血运重建或心力衰竭住院。

结果

在纳入的 1920 名患者中（84.5%为男性；平均年龄±标准差，56.4±10.5 岁），1013 名（52.8%）患有 OSA，718 名（37.4%）为肥胖（BMI≥28kg/m²）。在 2.9 年（1.5 至 3.6 年）的随访期间，肥胖患者的 MACCE 发生率明显高于非肥胖患者（风险比[HR]，1.29；95%CI，1.06-1.58；P=0.013）。尽管非肥胖患者的 OSA 患病率低于肥胖患者（43.9%比 67.5%；P<0.001），但 OSA 仅在非肥胖患者中独立预测 MACCE 的发生（校正 HR，1.34；95%CI，1.03-1.75；P=0.03），而在肥胖患者中则没有（校正 HR，1.10；95%CI，0.78-1.55；P=0.58）。未观察到肥胖与 OSA 之间存在显著交互作用（P 交互=0.35）。非肥胖患者中与 OSA 相关的额外风险可能归因于 ACS 和缺血驱动的血运重建的住院次数增加。