合并阻塞性睡眠呼吸暂停与代谢综合征合并急性冠状动脉综合征女性患者的不良心血管结局相关。
Comorbid obstructive sleep apnea is associated with adverse cardiovascular outcomes in female patients with acute coronary syndrome complicating metabolic syndrome.
机构信息
Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
出版信息
Clin Cardiol. 2023 Jun;46(6):663-673. doi: 10.1002/clc.24020. Epub 2023 Apr 14.
BACKGROUND
Obstructive sleep apnea (OSA) and metabolic syndrome (MetS) are each increasingly common in patients with acute coronary syndrome (ACS). Whether OSA increases cardiovascular consequences in ACS patients with MetS has not been investigated.
HYPOTHESIS
OSA increases cardiovascular risk in ACS patients with MetS. We aimed to examine the association between OSA and cardiovascular consequences in ACS patients with MetS.
METHODS
In this prospective cohort study, we consecutive recruited 2160 ACS patients who underwent portable sleep breathing monitoring. OSA is defined as an apnea-hypopnea index (AHI) ≥ 15 events/h. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure.
RESULTS
A total of 1927 patients with ACS were enrolled. Among them, 1486 (77.1%) had MetS and 1014 (52.6%) had OSA. During 2.9 years of follow-up, the cumulative incidence of MACCE was similar between OSA and non-OSA groups in patients with MetS (21.9% vs. 17.9%, adjusted hazard ratio [HR] = 1.29 95% confidence interval [CI]: 0.99-1.67, p = .06) and patients without MetS (24.4% vs. 17.3%, adjusted HR = 1.21 95% CI: 0.73-2.03, p = .46). Patients with MetS and OSA had a significantly higher risk of MACCE than patients with MetS and without OSA in women (27.8% vs. 18.1%, adjusted HR = 1.70, 95% CI: 1.01-3.09, p = .04) but not in men (21.0% vs. 17.9%, adjusted HR = 1.19, 95% CI: 0.91-1.59, p = .21).
CONCLUSIONS
In hospitalized ACS patients with MetS, comorbid OSA was associated with increased risk of cardiovascular consequences among women.
背景
阻塞性睡眠呼吸暂停（OSA）和代谢综合征（MetS）在急性冠状动脉综合征（ACS）患者中均越来越常见。OSA 是否会增加 MetS 合并 ACS 患者的心血管不良后果尚未得到研究。
假设
OSA 会增加 MetS 合并 ACS 患者的心血管风险。我们旨在研究 OSA 与 MetS 合并 ACS 患者心血管不良后果之间的关联。
方法
在这项前瞻性队列研究中，我们连续招募了 2160 名接受便携式睡眠呼吸监测的 ACS 患者。OSA 的定义为呼吸暂停低通气指数（AHI）≥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、心肌梗死、卒中等缺血驱动的血运重建，或因不稳定型心绞痛或心力衰竭住院。
结果
共纳入 1927 名 ACS 患者。其中，1486 名（77.1%）患有 MetS，1014 名（52.6%）患有 OSA。在 2.9 年的随访期间，在患有 MetS 的患者中，OSA 组和非 OSA 组的 MACCE 累积发生率相似（21.9%比 17.9%，调整后的危险比[HR] = 1.29，95%置信区间[CI]：0.99-1.67，p = 0.06）和没有 MetS 的患者（24.4%比 17.3%，调整后的 HR = 1.21，95% CI：0.73-2.03，p = 0.46）。患有 MetS 和 OSA 的女性患者发生 MACCE 的风险明显高于患有 MetS 但没有 OSA 的患者（27.8%比 18.1%，调整后的 HR = 1.70，95% CI：1.01-3.09，p = 0.04），但在男性患者中则没有（21.0%比 17.9%，调整后的 HR = 1.19，95% CI：0.91-1.59，p = 0.21）。
结论
在患有 MetS 的住院 ACS 患者中，合并 OSA 与女性患者心血管不良后果的风险增加有关。
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