体位性阻塞性睡眠呼吸暂停与心血管结局

Positional obstructive sleep apnea and cardiovascular outcomes.

作者信息

Kang Hyojung, Chow Christine, Lobo Jennifer, Logan Jeongok, Bonner Heather, Cho Yeilim, Liu Xiaoyue, Mazimba Sula, Kwon Younghoon

机构信息

Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, IL, 61820, USA.

Department of Medicine, University of Washington, Seattle, WA, 98195, USA.

出版信息

Sleep Breath. 2025 May 20;29(3):190. doi: 10.1007/s11325-025-03342-y.

DOI:10.1007/s11325-025-03342-y

PMID:40392385

Abstract

BACKGROUND

A tendency to obstruct the upper airway is markedly increased in supine sleep. Positional obstructive sleep apnea (OSA) (POSA) occurs predominantly in the supine position. The implication of POSA in terms of future cardiovascular (CV) risk is unknown. We hypothesized that patients with POSA have decreased future CV risks compared to OSA patients without POSA (non-POSA).

METHODS

This single-center study included patients who underwent clinically indicated polysomnography. POSA was defined as an apnea-hypopnea index (AHI) ≥ 5 events/hour and supine AHI at least twice as high as non-supine AHI (nsAHI). Exclusive POSA (ePOSA) includes the additional requirement that the nsAHI normalizes to an AHI of < 5/hour. A Cox proportional hazard model was used to assess the future risk of new CV events in patients with POSA compared to non-POSA (reference group).

RESULTS

There were 3,779 patients (mean age 51, female 59.7%), consisting of 35.9% POSA, 38.4% non-POSA, and 25.7% no OSA. Using the ePOSA definition, 17.3% had ePOSA, 57.1% had non-ePOSA, and 25.7% had no OSA. Over a median 8.4 years, there were 1,297 composite events. Patients with POSA had a lower risk of CV events compared to non-POSA (HR 0.85, CI:0.74-0.96; p = 0.010). There was a non-significant trend towards lower risk of CV events in patients with ePOSA compared to non-ePOSA (HR 0.86, CI:0.73-1.01; p = 0.061).

CONCLUSIONS

POSA is associated with lower CV risk than non-POSA. Future studies should consider POSA as a distinct subtype when studying OSA and CV outcomes.

摘要

背景

仰卧睡眠时上气道阻塞的倾向显著增加。体位性阻塞性睡眠呼吸暂停（OSA）（POSA）主要发生在仰卧位。POSA对未来心血管（CV）风险的影响尚不清楚。我们假设，与无POSA的OSA患者（非POSA）相比，POSA患者未来的CV风险降低。

方法

这项单中心研究纳入了接受临床指征多导睡眠图检查的患者。POSA定义为呼吸暂停低通气指数（AHI）≥5次/小时，且仰卧位AHI至少是非仰卧位AHI（nsAHI）的两倍。单纯性POSA（ePOSA）还要求nsAHI恢复正常，即AHI<5次/小时。使用Cox比例风险模型评估POSA患者与非POSA患者（参照组）未来发生新的CV事件的风险。

结果

共有3779例患者（平均年龄51岁，女性占59.7%），其中35.9%为POSA，38.4%为非POSA，25.7%无OSA。采用ePOSA定义时，17.3%为ePOSA，57.1%为非ePOSA，25.7%无OSA。在中位8.4年的时间里，共发生1297例复合事件。与非POSA患者相比，POSA患者发生CV事件的风险较低（风险比0.85，95%置信区间：0.74-0.96；p=0.010）。与非ePOSA患者相比，ePOSA患者发生CV事件的风险有降低趋势，但无统计学意义（风险比0.86，95%置信区间：0.73-1.01；p=0.061）。