重叠综合征与房颤的相关性分析

Correlation analysis between overlap syndrome and atrial fibrillation

目的探讨不同严重程度的重叠综合征与房颤发生的相关性。方法回顾性分析2011年1月至2014年12月于北京安贞医院接受便携式睡眠监测的1 939例患者的临床资料。呼吸暂停低通气指数(apnea-hypopnea in-dex,AHI)≥15次/h作为诊断阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)的标准。慢性阻塞性肺疾病(chronicobstructive pulmonary disease,COPD)的诊断均由当时主管医生根据临床表现和肺功能检查结果确定,同时罹患OSA与COPD者诊断重叠综合征。采用多因素logistic回归分析房颤的独立相关因素。结果与对照组相比,重叠综合征患者房颤的发生几率大(OR=6.71,95%CI:3.81~11.86,P<0.001),这一差异在矫正人口学与合并症后仍有统计学意义(OR=2.04,95%CI:1.09~3.78,P=0.025)。亚组分析显示,在非重度OSA(15次/h≤AHI<30次/h)和重度OSA(AHI≥30次/h)患者中,重叠综合征与房颤的发生几率增加均具有相关性(OR=4.49,95%CI:1.69~11.97,P=0.003和OR=2.38,95%CI:1.06~5.10,P=0.036)。结论重叠综合征与房颤的发生显著相关。

Objective To evaluate the association between stratified overlap syndrome and atrial fibrillation （AF） prevalence. Methods 1 939 patients completing portable sleep test during January 2011 to December 2014 were retrospectively studied. Patients with apnea-hypopnea index（AHI） ≥ 15/h were regarded to have obstructive sleep apnea （OSA）, and the diagnosis of chronic obstructive pulmonary disease （COPD） was at the discretion of the clinician on the basis of clinical symptom, signs, and spirometry. Overlap syndrome referred to the simultaneous diagnosis of OSA and COPD. Logistic analysis was used to evaluate the factors associated with AF prevalence. Results Compared with controls, patients with overlap syndrome had higher odds olAF （OR = 6.71, 95%CI：3.81-11.86, P 〈 0.001）, with significance persisting after adjusting for demography and commodities （OR = 2.04, 95%CI：1.09-3.78, P = 0.025）. In subgroup analysis, overlap syndrome was proved to be associated with higher odds of AF in patients with non-severe OSA （15/h≤AHI〈30/h） and severe （AHI≥30/h） （OR = 4.49, 95%CI：1.69-11.97, P= 0.003 and OR = 2.38, 95%CI：1.06-5.10, P= 0.036）. Conclusion Overlap syndrome is closely associated with AF prevalence.