School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
Sleep Health. 2024 Jun;10(3):335-341. doi: 10.1016/j.sleh.2024.03.001. Epub 2024 May 3.
To investigate the association between comorbid obstructive sleep apnea and insomnia and major adverse cardiovascular events, including myocardial infarction, unstable angina, congestive heart failure, and stroke, in adults with suspected sleep disorders who underwent sleep apnea testing.
We conducted a retrospective analysis of electronic medical records data from patients with clinical encounters at sleep medicine centers to identify patients with comorbid obstructive sleep apnea and insomnia, obstructive sleep apnea only, insomnia only, and patients without a diagnosis of obstructive sleep apnea or insomnia (i.e., controls). Obstructive sleep apnea, insomnia, comorbidities, and new-onset major adverse cardiovascular events were ascertained by ICD-9-CM and ICD-10-CM codes. Multivariable adjusted Cox proportional regression models evaluated the risk of major adverse cardiovascular events over a 10-year follow-up period.
A total of 3951 patients, 226 controls, 2107 with obstructive sleep apnea only, 276 with insomnia only, and 1342 with comorbid obstructive sleep apnea and insomnia, were included in the analysis. Compared to controls, comorbid obstructive sleep apnea and insomnia were associated with a significantly higher risk of developing major adverse cardiovascular events (hazard ratio 3.60, 95 CI%: 2.33-5.91) in unadjusted analyses. The relationship between comorbid obstructive sleep apnea and insomnia and major adverse cardiovascular events remained after adjustment for demographic and behavioral factors, but not after further adjustment for comorbidities. The greatest risk of major adverse cardiovascular events was found among younger adults with comorbid obstructive sleep apnea and insomnia. Obstructive sleep apnea only was associated with greater risk of major adverse cardiovascular events in unadjusted analyses only (hazard ratio 2.77, 95% CI: 1.80-4.54). Insomnia only was not significantly associated with increased risk of major adverse cardiovascular events.
Comorbid obstructive sleep apnea and insomnia may be a high-risk group for major adverse cardiovascular events, particularly younger adults. Further research is needed to better understand the association between comorbid obstructive sleep apnea and insomnia and major adverse cardiovascular events risk.
研究阻塞性睡眠呼吸暂停合并失眠与疑似睡眠障碍患者睡眠呼吸暂停检测后主要不良心血管事件（包括心肌梗死、不稳定型心绞痛、充血性心力衰竭和中风）之间的关联。
我们对睡眠医学中心临床就诊患者的电子病历数据进行回顾性分析，以确定合并阻塞性睡眠呼吸暂停和失眠、单纯阻塞性睡眠呼吸暂停、单纯失眠以及无阻塞性睡眠呼吸暂停或失眠诊断（即对照组）的患者。通过 ICD-9-CM 和 ICD-10-CM 编码确定阻塞性睡眠呼吸暂停、失眠、合并症和新发主要不良心血管事件。多变量调整 Cox 比例风险回归模型评估了 10 年随访期间主要不良心血管事件的风险。
共纳入 3951 例患者，其中 226 例为对照组，2107 例为单纯阻塞性睡眠呼吸暂停，276 例为单纯失眠，1342 例为合并阻塞性睡眠呼吸暂停和失眠。与对照组相比，未调整分析中合并阻塞性睡眠呼吸暂停和失眠与发生主要不良心血管事件的风险显著增加（风险比 3.60，95%CI%：2.33-5.91）。在调整人口统计学和行为因素后，合并阻塞性睡眠呼吸暂停和失眠与主要不良心血管事件之间的关系仍然存在，但在进一步调整合并症后则不然。在合并阻塞性睡眠呼吸暂停和失眠的年轻成年人中，主要不良心血管事件的风险最高。仅阻塞性睡眠呼吸暂停在未调整分析中与主要不良心血管事件风险增加相关（风险比 2.77，95%CI：1.80-4.54）。单纯失眠与主要不良心血管事件风险增加无显著相关性。
合并阻塞性睡眠呼吸暂停和失眠可能是主要不良心血管事件的高危人群，尤其是年轻成年人。需要进一步研究以更好地了解合并阻塞性睡眠呼吸暂停和失眠与主要不良心血管事件风险之间的关系。
