Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China.
J Sleep Res. 2023 Oct;32(5):e13898. doi: 10.1111/jsr.13898. Epub 2023 Apr 5.
The clinical outcome of obstructive sleep apnea in patients with acute coronary syndrome in relation to hyperuricemia is still unclear. We aimed to explore the clinical prognosis of obstructive sleep apnea in patients with acute coronary syndrome in relation to hyperuricemia status. This was a prospective cohort study. We included consecutively eligible patients with acute coronary syndrome who underwent cardiorespiratory polygraphy between June 2015 and January 2020. According to apnea-hypopnea index ≥ 15 events per hr and serum uric acid level, the population was divided into four groups: hyperuricemia with obstructive sleep apnea; hyperuricemia with non-obstructive sleep apnea; no hyperuricemia with obstructive sleep apnea; and no hyperuricemia with non-obstructive sleep apnea. The primary endpoint was major adverse cardiovascular and cerebrovascular events, including cardiovascular death, myocardial infarction, stroke, ischaemia-driven revascularization, and readmission for unstable angina or heart failure. Spearman correlation analysis and Cox regression model were mainly used to estimate the data. The median follow-up was 2.9 years. Among 1925 patients with acute coronary syndrome, 29.6% had hyperuricemia and 52.6% had obstructive sleep apnea. Uric acid was negatively correlated with minimum arterial oxygen saturation and mean arterial oxygen saturation, and positively correlated with apnea-hypopnea index, oxygen desaturation index and the duration of time with arterial oxygen saturation < 90% (p < 0.001). During 2.9 (1.5, 3.6) years of follow-up, obstructive sleep apnea was associated with an increased risk of major adverse cardiovascular and cerebrovascular events in patients with hyperuricemia (23.5% versus 13.4%; adjusted hazard ratio: 1.834; 95% confidence interval: 1.192-2.821, p = 0.006), but not in patients without hyperuricemia (21.9% versus 19.2%; adjusted hazard ratio: 1.131; 95% confidence interval: 0.880-1.453, p = 0.336). There was a correlation between uric acid levels and sleep respiratory indicators. Obstructive sleep apnea was associated with increased risk of major adverse cardiovascular and cerebrovascular events in patients with acute coronary syndrome with hyperuricemia, but not in patients without hyperuricemia.
急性冠状动脉综合征患者中阻塞性睡眠呼吸暂停与高尿酸血症的临床转归尚不清楚。我们旨在探讨急性冠状动脉综合征患者中阻塞性睡眠呼吸暂停与高尿酸血症状态的临床预后。这是一项前瞻性队列研究。我们纳入了 2015 年 6 月至 2020 年 1 月期间接受心肺多导睡眠图检查的连续合格的急性冠状动脉综合征患者。根据呼吸暂停低通气指数（apnea-hypopnea index，AHI）≥15 次/小时和血清尿酸水平，人群分为四组：高尿酸血症伴阻塞性睡眠呼吸暂停；高尿酸血症伴非阻塞性睡眠呼吸暂停；非高尿酸血症伴阻塞性睡眠呼吸暂停；非高尿酸血症伴非阻塞性睡眠呼吸暂停。主要终点是主要不良心血管和脑血管事件，包括心血管死亡、心肌梗死、卒中等缺血驱动的血运重建以及不稳定型心绞痛或心力衰竭再入院。主要使用 Spearman 相关分析和 Cox 回归模型来估计数据。中位随访时间为 2.9 年。在 1925 例急性冠状动脉综合征患者中，29.6%患有高尿酸血症，52.6%患有阻塞性睡眠呼吸暂停。尿酸与最低动脉血氧饱和度和平均动脉血氧饱和度呈负相关，与呼吸暂停低通气指数、氧减饱和度指数和动脉血氧饱和度＜90%的时间呈正相关（p＜0.001）。在 2.9（1.5，3.6）年的随访期间，在伴有高尿酸血症的患者中，阻塞性睡眠呼吸暂停与主要不良心血管和脑血管事件的风险增加相关（23.5%比 13.4%；调整后的危险比：1.834；95%置信区间：1.192-2.821，p=0.006），但在不伴有高尿酸血症的患者中则无相关性（21.9%比 19.2%；调整后的危险比：1.131；95%置信区间：0.880-1.453，p=0.336）。尿酸水平与睡眠呼吸指标之间存在相关性。在伴有高尿酸血症的急性冠状动脉综合征患者中，阻塞性睡眠呼吸暂停与主要不良心血管和脑血管事件的风险增加相关，但在不伴有高尿酸血症的患者中则无相关性。
