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.
Sleep Med. 2023 Oct;110:132-136. doi: 10.1016/j.sleep.2023.07.035. Epub 2023 Aug 2.
The objective of this study was to evaluate the interaction between obesity and obstructive sleep apnea on acute MI in hospital mortality.
This retrospective cohort study utilized Veterans Health Administration data from years 1999-2020. Participants were categorized according to their body mass index (BMI) to non-obese (BMI <30) and obese (BMI ≥30) groups. Clinical obstructive sleep apnea (SA) diagnosis was confirmed using ICD9/10 codes and the study subgroups included non-obese with no obstructive sleep apnea (nOB-nSA), non-Obese with obstructive sleep apnea (nOB-SA), obese with no obstructive sleep apnea (OB-nSA), and obese with obstructive sleep apnea (OB-SA). The primary outcome was odds ratio of in-hospital mortality during the hospitalization with acute MI as the principal diagnosis adjusted for age, gender, race, ethnicity, and Charlson comorbidity index (CCI) with the nOB-nSA group as the comparison group.
Among 72,036 veterans with acute-MI hospitalization, individuals with obesity and obstructive sleep apnea (OB-SA) had the lowest in-hospital mortality rate (1.0%) compared to those without obesity and obstructive sleep apnea (nOB-nSA, 2.8%), with obesity but without obstructive sleep apnea (OB-nSA, 2.4%), and with obesity and obstructive sleep apnea (nOB-SA, 1.4%). The adjusted odds ratio for mortality, compared to nOB-nSA, was 9% higher but not significant in OB-nSA (aOR, 1.09, 95%CI: 0.95, 1.25), 46% lower in OB-nSA (aOR, 0.54, 95%CI: 0.45, 0.66), and 52% lower in OB-SA (aOR, 0.48: 95%CI: 0.41, 0.57).
Our data suggest that the association between obesity and improved survival in acute MI is largely driven by the presence of sleep apnea.
本研究旨在评估肥胖症和阻塞性睡眠呼吸暂停（OSA）对住院期间急性心肌梗死（MI）死亡率的相互作用。
本回顾性队列研究利用了退伍军人健康管理局（Veterans Health Administration） 1999 年至 2020 年的数据。参与者根据体重指数（BMI）分为非肥胖（BMI＜30）和肥胖（BMI≥30）组。临床阻塞性睡眠呼吸暂停（SA）诊断采用 ICD9/10 编码确认，研究亚组包括非肥胖且无阻塞性睡眠呼吸暂停（nOB-nSA）、非肥胖且阻塞性睡眠呼吸暂停（nOB-SA）、肥胖且无阻塞性睡眠呼吸暂停（OB-nSA）和肥胖且阻塞性睡眠呼吸暂停（OB-SA）。主要结局是将急性 MI 住院期间的住院死亡率作为主要诊断，调整年龄、性别、种族、民族和 Charlson 合并症指数（CCI），以 nOB-nSA 组为对照组，评估肥胖症和阻塞性睡眠呼吸暂停（OSA）对其的影响。
在 72036 名患有急性 MI 住院的退伍军人中，与非肥胖且无阻塞性睡眠呼吸暂停（nOB-nSA）、肥胖但无阻塞性睡眠呼吸暂停（OB-nSA）和肥胖且阻塞性睡眠呼吸暂停（OB-SA）患者相比，肥胖且阻塞性睡眠呼吸暂停（OB-SA）患者的住院死亡率最低（1.0%）。调整后的死亡率与 nOB-nSA 相比，在 OB-nSA 中，死亡风险增加了 9%，但无统计学意义（优势比[aOR]，1.09；95%CI：0.95，1.25），在 OB-SA 中，死亡风险降低了 46%（aOR，0.54；95%CI：0.45，0.66），在 OB-SA 中，死亡风险降低了 52%（aOR，0.48；95%CI：0.41，0.57）。
我们的数据表明，肥胖症和急性 MI 患者生存率提高之间的关联在很大程度上是由阻塞性睡眠呼吸暂停引起的。
