阻塞性睡眠呼吸暂停对心力衰竭急性冠状动脉综合征患者的预后影响。

Prognostic effect of obstructive sleep apnea in acute coronary syndrome patients with heart failure.

机构信息

Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China.

Department of Cardiology, China-Japan Friendship Hospital, Beijing, China.

出版信息

Respir Med. 2024 Nov-Dec;234:107814. doi: 10.1016/j.rmed.2024.107814. Epub 2024 Sep 21.

DOI:10.1016/j.rmed.2024.107814

PMID:39307479

Abstract

BACKGROUND AND OBJECTIVE

Acute coronary syndrome (ACS), heart failure (HF) and obstructive sleep apnea (OSA) often overlap and interact, the impact of OSA on ACS patients with HF remains unclear. The study sought to comprehensively evaluate the effects of the interaction between OSA and HF on long-term cardiovascular outcomes in ACS patients.

METHODS

Between June 2015 and January 2020, patients hospitalized for ACS were prospectively enrolled and underwent portable sleep monitoring after clinically stabilization. OSA was defined as an apnea hypopnea index ≥15 events/h. HF was defined using medical records. The primary endpoint was major adverse cardiovascular and cerebrovascular event (MACCE), including death, myocardial infarction, stroke, ischemia-driven revascularization, and hospitalization for unstable angina.

RESULTS

Among all 1927 included patients, 214 (11.1 %) had HF, and 1014 (52.6 %) had OSA. For 2.9 years (1.5, 3.6 years) follow-up, OSA was independently associated with the risk of MACCE in HF patients (adjusted hazard ratio [HR], 2.11; 95%CI, 1.16-3.84; P = 0.014), but not in those without HF (adjusted HR, 1.15; 95%CI, 0.92-1.45; P = 0.228). Further analysis showed OSA exerted more prognostic effect in HF patients with preserved eject fraction (adjusted HR, 2.45; 95 % CI, 1.11-5.41; P = 0.027) than those with reduced eject fraction (adjusted HR, 1.62; 95 % CI, 0.63-4.20; P = 0.319).

CONCLUSIONS

In the settings of ACS, OSA was independently associated with poor prognosis in patients with concomitant HF especially those with persevered ejection fraction. Screening and treatment for OSA are highly recommended in ACS patients with HF.

CLINICAL TRIAL REGISTRATION

URL: www.clinicaltrails.gov; Unique Identifier: NCT03362385.

摘要

背景和目的

急性冠状动脉综合征（ACS）、心力衰竭（HF）和阻塞性睡眠呼吸暂停（OSA）经常重叠和相互作用，OSA 对 ACS 合并 HF 患者的影响尚不清楚。本研究旨在全面评估 OSA 和 HF 之间相互作用对 ACS 患者长期心血管结局的影响。

方法

2015 年 6 月至 2020 年 1 月，前瞻性纳入因 ACS 住院的患者，在临床稳定后进行便携式睡眠监测。OSA 定义为呼吸暂停低通气指数≥15 次/小时。HF 采用病历定义。主要终点是主要不良心血管和脑血管事件（MACCE），包括死亡、心肌梗死、卒中和缺血驱动的血运重建以及不稳定型心绞痛住院。

结果

在所有纳入的 1927 例患者中，214 例（11.1%）患有 HF，1014 例（52.6%）患有 OSA。随访 2.9 年（1.5 至 3.6 年），OSA 与 HF 患者发生 MACCE 的风险独立相关（调整后的危险比[HR]，2.11；95%CI，1.16-3.84；P=0.014），但与无 HF 的患者无关（调整后的 HR，1.15；95%CI，0.92-1.45；P=0.228）。进一步分析显示，OSA 在射血分数保留的 HF 患者中比射血分数降低的 HF 患者具有更显著的预后作用（调整后的 HR，2.45；95%CI，1.11-5.41；P=0.027）。