阻塞性睡眠呼吸暂停低通气综合征对冠心病患者房颤风险影响的系统评价

Impact of obstructive sleep apnea hypopnea syndrome on risk of atrial fibrillation with coronary artery disease: a systematic review

目的 系统评价阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对冠心病患者房颤发病风险的影响。方法 计算机检索PubMed、EMbase、The Cochrane Library、SinoMed、CNKI、WanFang Data和VIP数据库,搜集OSAHS与冠心病或冠状动脉旁路移植术后房颤风险关系的队列研究,检索时限均从建库至2018年7月2日。由2名研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果 最终纳入11个队列研究,包括709例OSAHS患者和975例非OSAHS患者。Meta分析结果显示:OSAHS明显增加冠心病患者房颤的发病风险[RR=2.01,95%CI(1.72,2.36),P<0.000 01]。亚组分析结果显示:①采用多导睡眠监测(PSG)诊断的冠心病合并OSAHS患者发生房颤的风险增加[RR=2.40,95%CI(1.84,3.12),P<0.000 01],其中冠心病合并中重度OSAHS患者发生房颤的风险更高[RR=3.73,95%CI(2.51,5.53),P<0.000 01];②采用柏林问卷调查(BQ)评估的冠心病合并高风险OSAHS患者发生房颤的风险也比冠心病合并低风险OSAHS患者有所增加[RR=1.56,95%CI(1.27,1.92),P<0.000 1]。结论 现有证据表明,合并OSAHS明显增加冠心病患者房颤的发病风险。受纳入研究质量和数量的限制,上述结论尚需开展大规模高质量的研究予以验证。

Objective To systematically review whether or not obstructive sleep apnea hypopnea syndrome(OSAHS)increases the incidence of atrial fibrillation in coronary artery disease patients.Methods PubMed,EMbase,The Cochrane Library,SinoMed,CNKI,VIP and WanFang Data databases were searched for studies on the relationship between OSAHS and the incidence of atrial fibrillation in coronary artery disease patients from inception to July2nd,2018.Two reviewers independently screened literatures,extracted data,and assessed the risk of bias of included studies.Then,meta-analysis was performed by RevMan5.3software.Results In total,11cohort studies were included,involving709in exposed group and975in non-exposed group.The results of meta-analysis indicated that OSAHS was associated with the incidence of atrial fibrillation in coronary artery disease patients(RR=2.01,95%CI1.72to2.36,P<0.00001).The subgroup analysis showed that OSAHS of PSG diagnosis increased the risk of the incidence of atrial fibrillation in coronary artery disease patients(RR=2.40,95%CI1.84to3.12,P<0.00001);moderate and severe OSAHS of PSG diagnosis had higher risk of the incidence of atrial fibrillation in coronary artery disease patients(RR=3.73,95%CI2.51to5.53,P<0.00001);high risk OSAHS of Berlin questionnaire assessment increased the incidence of atrial fibrillation in CAD patients(RR=1.56,95%CI1.27to1.92,P<0.0001).Conclusion The current evidence indicates that OSAHS is associated with an increased risk of atrial fibrillation in coronary artery disease patients.Due to the limitation of quality and quantity of the included studies,more large-scale and fine quality research are needed to warrant the accuracy of conclusion above.