Department of Pulmonology, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
Department of Neurology, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
Sleep Breath. 2024 Dec;28(6):2367-2378. doi: 10.1007/s11325-024-03137-7. Epub 2024 Aug 9.
Mortality predictors in obstructive sleep apnea (OSA) patients yet to be comprehensively understood, especially within large cohorts undergoing long-term follow-up. We aimed to determine the independent predictors of mortality in OSA patients.
In our retrospective cohort study, 3,541 patients were included and survival data was obtained from electronic medical records. Demographic characteristics, anthropometric measurements, comorbidities, laboratory tests, and polysomnography parameters were analyzed for the survived and deceased patient groups. Univariate and multivariate Cox regression analyses were performed to determine independent predictors of all-cause mortality in patients followed for at least 5 years.
Among all patients, 2,551 (72%) patients were male, with a mean age of 49.7 years. 231 (6.5%) patients had died. Deceased patients were significantly older and had higher waist-to-hip ratio and Epworth Sleepiness Scale (p < 0.001, p < 0.001, p = 0.003). OSA (nonpositional and not-rapid eye movement-related), periodic limb movements in sleep and Comorbidities of Sleep Apnea Score ≥ 1 were found to be associated with increased mortality (p < 0.001). Systemic immune-inflammation index was also significantly higher in the deceased group (p < 0.001). Higher oxygen desaturation index (ODI) and apnea-hypopnea index (AHI) were associated with increased mortality (p < 0.001). Due to the high correlation between ODI and AHI, two separate multivariate Cox regression models were created. While AHI lost its significance in the multivariate analysis, ODI remained significantly higher in the deceased patient group (HR = 1.007, 1.001-1.013, p = 0.01).
ODI, as the only polysomnography parameter, emerged as an independent predictor of mortality in OSA patients.
阻塞性睡眠呼吸暂停（OSA）患者的死亡率预测因素尚未得到全面理解，尤其是在接受长期随访的大型队列中。我们旨在确定 OSA 患者死亡的独立预测因素。
在我们的回顾性队列研究中，纳入了 3541 名患者，并从电子病历中获得了生存数据。对存活和死亡患者组进行了人口统计学特征、人体测量学测量、合并症、实验室检查和多导睡眠图参数分析。进行单变量和多变量 Cox 回归分析，以确定至少随访 5 年的患者全因死亡率的独立预测因素。
在所有患者中，2551 名（72%）患者为男性，平均年龄为 49.7 岁。231 名（6.5%）患者死亡。死亡患者年龄明显更大，且腰围-臀围比和 Epworth 嗜睡量表评分更高（p<0.001，p<0.001，p=0.003）。非体位性和非快速眼动相关的阻塞性睡眠呼吸暂停、睡眠周期性肢体运动和睡眠呼吸暂停合并症评分≥1 与死亡率增加相关（p<0.001）。死亡组的系统性免疫炎症指数也明显更高（p<0.001）。较高的氧减指数（ODI）和呼吸暂停低通气指数（AHI）与死亡率增加相关（p<0.001）。由于 ODI 和 AHI 之间存在高度相关性，因此分别创建了两个多变量 Cox 回归模型。虽然 AHI 在多变量分析中失去了意义，但 ODI 在死亡患者组中仍然显著升高（HR=1.007，1.001-1.013，p=0.01）。
ODI 作为唯一的多导睡眠图参数，是 OSA 患者死亡的独立预测因素。
