中重度阻塞性睡眠呼吸暂停增加心房颤动患者消融术后复发率

Moderate to severe obstructive sleep apnea increases the possibility of atrial fibrillation recurrence after catheter ablation

目的探讨阻塞性睡眠呼吸暂停(OSA)对心房颤动(房颤)患者导管消融术后维持窦性心律的影响。方法本研究为观察性队列研究。前瞻性入选2023年2月至12月在南京医科大学第一附属医院心血管内科首次接受消融的房颤患者,并于术前进行睡眠呼吸监测。基于呼吸暂停低通气指数(AHI),将患者分成无或轻度OSA组(AHI<15次/h)和中重度OSA组(AHI≥15次/h),比较两组患者基线资料、睡眠呼吸监测结果及房颤复发等指标。结果共入选104例房颤患者,年龄(59.36±10.31)岁,其中男70例(67.3%,70/104)。与无或轻度OSA组患者相比,中重度OSA组患者HAS-BLED评分[1.00(1.00,2.00)分对1.00(0,1.00)分,P=0.020]更高,左心房内径[(41.59±5.11)mm对(39.64±4.32)mm,P=0.037]更大,夜间平均血氧饱和度(94.72%±1.46%对95.81%±1.49%,P<0.001)更低。消融术后随访9.3(7.0,11.9)个月,17例(16.3%,17/104)患者房颤复发。中重度OSA组患者房颤复发率显著高于无或轻度OSA组[24.5%(12/49)对9.1%(5/55),Log-rank P=0.032],差异有统计学意义。多因素Cox回归分析显示,LDL-C(HR=2.34,95%CI 1.13~4.85,P=0.023),AHI≥15次/h(HR=3.20,95%CI 1.11~9.21,P=0.031)是房颤复发的独立危险因素。结论中重度OSA是房颤患者导管消融术后复发的独立危险因素。

Objective To explore the influence of obstructive sleep apnea(OSA)on maintaining sinus rhythm in patients with atrial fibrillation(AF)after catheter ablation.Methods This study is an observational cohort study that prospectively recruited patients who underwent their first catheter ablation of AF at the Department of Cardiology,The First Affiliated Hospital of Nanjing Medical University from February 2023 to December 2023.All the patients received sleep apnea test before the procedure.According to the test results,patients were divided into a group with no or mild OSA[apnea-hypopnea index(AHI)<15 times/h]and a group with moderate to severe OSA(AHI≥15 times/h).Baseline data and the recurrence of AF were collected,analyzed,and compared between the two groups.Results One hundred and four patients were included in the study[average age(59.36±10.31)years]and 70(67.3%,70/104)were males.There was a statistically significant difference in the HAS-BLED score[1.00(1.00,2.00)vs.1.00(0,1.00),P=0.020],left atrium diameter[(41.59±5.11)mm vs.(39.64±4.32)mm,P=0.037]and mean blood oxygen saturation(94.72%±1.46%vs.95.81%±1.49%,P<0.001)between the the group with moderate to severe OSA and the group with no or mild OSA.After follow-up of 9.3(7.0,11.9)months,a total of 17 patients(16.3%,17/104)experienced AF recurrence.The recurrence rate of AF in the group with moderate to severe OSA was significantly higher than that in the group with no or mild OSA[24.5%(12/49)vs.9.1%(5/55),Log-rank P=0.032].Multivariate Cox regression analysis found that AHI≥15 times/h(HR=3.20,95%CI 1.11-9.21,P=0.031)and low density lipoprotein cholesterol(HR=2.34,95%CI 1.13-4.85,P=0.023)were the independent risk factors for AF recurrence.Conclusion Moderate to severe OSA is an independent risk factor for the recurrence of AF after catheter ablation.