摘要
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.
作者
甄雷
王宾
王晓
公威
艾辉
阙斌
聂绍平
ZHEN Lei;WANG Bin;WANG Xiao;GONG Wei;AI Hui;QUE Bin;NIE Shaoping(Center for Coronary Artery Disease,Division of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)
出处
《心肺血管病杂志》
CAS
2023年第5期421-426,共6页
Journal of Cardiovascular and Pulmonary Diseases
基金
国家重点研发计划(2020YFC2004800)
国家自然科学基金(81970292,82100260,82270258,82200495)。