Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Pulmonary, Critical Care and Sleep Medicine Section, Medical Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA.
Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Pulmonary, Critical Care and Sleep Medicine Section, Medical Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA.
Respir Med. 2023 May;211:107214. doi: 10.1016/j.rmed.2023.107214. Epub 2023 Mar 15.
While the longer-term Obstructive Sleep apnea (OSA)-related intermittent hypoxia (IH) leads to various comorbidities, it has become increasingly evident that OSA confers protective advantages during and after acute myocardial infarction (AMI). We hypothesized in patients who were admitted with acute MI, the presence of OSA is associated with lower in-hospital mortality compared to those without a prior diagnosis of OSA.
In this nationwide retrospective study utilizing Veterans Health Administration records, we included patients hospitalized for MI with a history of sleep disorders from 1999 to 2020. We divided patients into two cohorts: those with OSA and those without OSA. The primary outcome was in-hospital mortality during AMI hospitalization. We analyzed the data using logistic regression and calculated the odds ratio of in-hospital mortality.
Out of more than four million veterans with any sleep diagnosis, 76,359 patients were hospitalized with a diagnosis of AMI. We observed 30,116 with OSA (age, 64 ± 10 years; BMI, 33 ± 7 kg/m) and 43,480 without OSA (age, 68 ± 12 years; BMI, 29 ± 6 kg/m). The aOR of in-patient mortality (n = 333 (1.1%)) was lower in those with OSA (aOR, 0.43; 95% CI, 0.38 to 0.49) compared to without-OSA (n = 1,102, 2.5%). However, the OSA cohort had a higher proportion of the prolonged length of stay (28.1%).
Presence of OSA is associated with lower in-hospital mortality among patients admitted for AMI, after adjusting for various demographic and co-morbidity factors. This study highlights the complex relationship between OSA and cardiovascular health and highlights the need for further research in this area.
尽管阻塞性睡眠呼吸暂停（OSA）相关的间歇性低氧（IH）的长期影响会导致各种合并症，但越来越明显的是，OSA 在急性心肌梗死（AMI）期间和之后提供了保护优势。我们假设，在因 AMI 入院的患者中，与没有先前 OSA 诊断的患者相比，存在 OSA 与住院期间死亡率较低相关。
在这项利用退伍军人健康管理局记录的全国性回顾性研究中，我们纳入了 1999 年至 2020 年期间因睡眠障碍住院并患有 MI 的患者。我们将患者分为两组：一组患有 OSA，另一组没有 OSA。主要结局是 AMI 住院期间的院内死亡率。我们使用逻辑回归分析数据，并计算了住院期间死亡率的优势比。
在超过四百万名有任何睡眠诊断的退伍军人中，有 76359 名患者因 AMI 住院。我们观察到 30116 例 OSA（年龄 64 ± 10 岁；BMI 33 ± 7 kg/m）和 43480 例非 OSA（年龄 68 ± 12 岁；BMI 29 ± 6 kg/m）。患有 OSA 的患者（n=333（1.1%））的住院死亡率的优势比（OR）较低（OR，0.43；95%置信区间，0.38 至 0.49），而非 OSA 患者（n=1102，2.5%）。然而，OSA 组的住院时间延长比例更高（28.1%）。
在调整了各种人口统计学和合并症因素后，患有 OSA 的 AMI 患者的住院死亡率较低。这项研究强调了 OSA 与心血管健康之间的复杂关系，并强调了在这一领域进一步研究的必要性。
