阻塞性睡眠呼吸暂停患者急性ST段抬高型心肌梗死发作的昼夜模式

Day-night pattern of acute ST-segment elevation myocardial infarction onset in patients with obstructive sleep apnea.

作者信息

Wang Yueying, Buayiximu Keremu, Zhu Tianqi, Yan Renyu, Zhu Zhengbin, Ni Jingwei, Du Run, Zhu Jinzhou, Wang Xiaoqun, Ding Fenghua, Yan Xiaoxiang, Qu Xuezheng, Li Ping, Zhang Ruiyan, Xu Zhihong, Quan Weiwei

机构信息

Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

出版信息

J Clin Sleep Med. 2024 May 1;20(5):765-775. doi: 10.5664/jcsm.10990.

DOI:10.5664/jcsm.10990

PMID:38174863

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11063706/

Abstract

STUDY OBJECTIVES

Obstructive sleep apnea (OSA) is associated with acute nocturnal hemodynamic and neurohormonal abnormalities that may increase the risk of coronary events, especially during the nighttime. This study sought to investigate the day-night pattern of acute ST-segment elevation myocardial infarction (STEMI) onset in patients with OSA and its impact on cardiovascular adverse events.

METHODS

We prospectively enrolled 397 patients with STEMI, for which the time of onset of chest pain was clearly identified. All participants were categorized into non-OSA (n = 280) and OSA (n = 117) groups. The association between STEMI onset time and major adverse cardiovascular and cerebrovascular events was estimated by Cox proportional hazards regression.

RESULTS

STEMI onset occurred from midnight to 5:59 am in 33% of patients with OSA, as compared with 15% in non-OSA patients ( < .01). For individuals with OSA, the relative risk of STEMI from midnight to 5:59 am was 2.717 [95% confidence interval (CI) 1.616 - 4.568] compared with non-OSA patients. After a median of 2.89 ± 0.78 years follow-up, symptom onset time was found to be significantly associated with risk of major adverse cardiovascular and cerebrovascular events in patients with OSA, while there was no significant association observed in non-OSA patients. Compared with STEMI presenting during noon to 5:59 pm, the hazard ratios for major adverse cardiovascular and cerebrovascular events in patients with OSA were 4.683 (95% CI 2.024 - 21.409, = .027) for midnight to 5:59 am and 6.964 (95% CI 1.379 - 35.169, = .019) for 6 pm to midnight, whereas the hazard ratios for non-OSA patients were 1.053 (95% CI 0.394 - 2.813, = .917) for midnight to 5:59 am and 0.745 (95% CI 0.278 - 1.995, = .558) for 6 pm to midnight.

CONCLUSIONS

Patients with OSA exhibited a peak incidence of STEMI between midnight and 5:59 am, which showed an independent association with cardiovascular adverse events.

CITATION

Wang Y, Buayiximu K, Zhu T, et al. Day-night pattern of acute ST-segment elevation myocardial infarction onset in patients with obstructive sleep apnea. . 2024;20(5):765-775.

摘要

研究目的

阻塞性睡眠呼吸暂停（OSA）与急性夜间血流动力学和神经激素异常有关，这可能会增加冠状动脉事件的风险，尤其是在夜间。本研究旨在调查OSA患者急性ST段抬高型心肌梗死（STEMI）发病的昼夜模式及其对心血管不良事件的影响。

方法

我们前瞻性纳入了397例STEMI患者，这些患者胸痛发作时间明确。所有参与者被分为非OSA组（n = 280）和OSA组（n = 117）。通过Cox比例风险回归估计STEMI发病时间与主要心血管和脑血管不良事件之间的关联。

结果

33%的OSA患者STEMI发作发生在午夜至凌晨5:59，而非OSA患者为15%（P <.01）。对于OSA患者，与非OSA患者相比，午夜至凌晨5:59发生STEMI的相对风险为2.717[95%置信区间（CI）1.616 - 4.568]。经过中位2.89±0.78年的随访，发现症状发作时间与OSA患者主要心血管和脑血管不良事件的风险显著相关，而非OSA患者未观察到显著关联。与中午至下午5:59出现的STEMI相比，OSA患者午夜至凌晨5:59主要心血管和脑血管不良事件的风险比为4.683（95%CI 2.024 - 21.409，P =.027），下午6点至午夜为6.964（95%CI 1.379 - 35.169，P =.019），而非OSA患者午夜至凌晨5:59的风险比为1.053（95%CI 0.394 - 2.813，P =.917），下午6点至午夜为0.745（95%CI 0.278 - 1.995，P =.558）。

结论

OSA患者在午夜至凌晨5:59之间STEMI发病率最高，这与心血管不良事件存在独立关联。

引用文献

Wang Y, Buayiximu K, Zhu T, et al. Day-night pattern of acute ST-segment elevation myocardial infarction onset in patients with obstructive sleep apnea.. 2024;20(5):765-775.