阻塞性睡眠呼吸暂停对青年男性急性冠状动脉综合征患者远期预后的影响

Effects of obstructive sleep apnea on the long-term cardiovascular outcomes in young men patients with acute coronary syndrome

目的:探讨阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)对青年男性急性冠状动脉综合征(acute coronary syndrome,ACS)患者远期预后的影响。方法:本研究是基于一项单中心、前瞻性队列研究OSA-ACS的亚组分析,纳入研究对象为青年男性ACS患者。选取2015年6月至2020年1月,于首都医科大学附属北京安贞医院住院的ACS患者,均行便携式睡眠呼吸监测检查。根据睡眠呼吸暂停低通气指数(apnea hypopnea index,AHI)将患者分为中/重度OSA组(AHI≥15次/h)和无/轻度OSA组(AHI<15次/h)。主要终点为主要不良心脑血管事件(major adverse cardiac and cerebrovascular events,MACCE),即包括心原性死亡、非致死性心肌梗死、非致死性卒中、缺血驱动的血运重建、因不稳定性心绞痛或心力衰竭再入院的复合终点。绘制两组发生MACCE的Kaplan-Meier曲线。采用多因素Cox回归分析青年男性ACS患者发生MACCE的预测因素。结果:本研究共纳入青年男性ACS患者235例,其中中/重度OSA组132例,无/轻度OSA组103例。随访时间为2.9(1.5,3.6)年,Kaplan-Meier生存曲线显示,与无/轻度OSA组比较,中/重度OSA组MACCE累积发生率更高(18.9%vs.9.7%,HR=2.434,95%CI:1.078~5.498,Log-rank P=0.043)。多因素Cox回归分析结果显示,中/重度OSA(HR=2.434,95%CI:1.078~5.498,P=0.032)是青年男性ACS患者远期MACCE的独立预测。结论:在青年男性ACS患者中,超过56.2%的患者合并OSA,OSA是青年男性ACS患者远期MACCE的独立预测因素。

Objective:To investigate the relationship between obstructive sleep apnea(OSA)and long‑term cardiovascular outcomes in young men patients with acute coronary syndrome(ACS).Methods:This study was a post hoc analysis of OSA-ACS,which is a large,single-center,prospective cohort study,that only young men patients were enrolled.From June 2015 to January 2020,ACS patients hospitalized at Beijing Anzhen Hospital,Capital Medical University were enrolled.Patients were divided into moderate/severe OSA group[apnea-hypopnea index(AHI)≥15 events/h]and no/mild OSA group(AHI<15 events/h).The primary endpoint was major adverse cardiac and cerebrovascular event(MACCE),defined as a composite of cardiovascular death,non-fatal myocardial infarction,non-fatal stroke,ischemia-driven revascularization and hospital admission for unstable angina or heart failure.MACCE were summarized as Kaplan-Meier estimates and were compared by the log-rank test.Multivariable Cox regression analyses were performed to determine independent predictors of MACCE.Results:A total of 235 patients with ACS were enrolled,including 132(56.2%)patients in moderate/severe OSA group.During a follow-up[median 2.9(1.5,3.6 years)],the cumulative incidence of MACCE was significantly higher in the moderate/severe OSA group than in the no/mild OSA group(18.9%vs.9.7%,HR=2.434,95%CI:1.078-5.498,Log-rank,P=0.043).Multivariate Cox regression analysis showed that moderate/severe OSA(HR=2.434,95%CI:1.078-5.498,P=0.032)was independent predictor of long-term MACCE in ACS patients.Conclusions:Moderate/severe OSA was observed in 56.2%of young men ACS patients,which was an independent predictor of long-term MACCE.