Association of sleep-disordered breathing and the occurrence of stroke
Association of sleep-disordered breathing and the occurrence of stroke
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DOI：
10.1164/rccm.200505-702oc
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发表时间：
2005-12-01
影响因子：
24.7
通讯作者：
Bradley, TD
中科院分区：
文献类型：
--
作者：
Arzt, M;Young, T;Bradley, TD
依据：睡眠呼吸障碍在以前的研究中与中风有关。然而，这些研究要么使用替代标记的睡眠呼吸障碍或不能，由于横截面设计，解决睡眠呼吸障碍和stroke.Objectives之间的时间关系：为了确定是否睡眠呼吸障碍增加中风的风险。方法：我们进行了横向和纵向分析1,475和1,189名受试者，分别从一般人群。睡眠呼吸障碍的定义是由多导睡眠图获得的呼吸暂停低通气指数（每小时睡眠呼吸暂停和低通气的频率）。该方案，包括多导睡眠图，中风的危险因素，以及医生诊断的中风史，每4年重复一次。测量和主要结果：在横断面分析中，呼吸暂停低通气指数为20或更高的受试者中风的几率增加（比值比，4.33; 95%可信区间，1.32-14.24; p = 0.02）与无睡眠呼吸障碍（呼吸暂停低通气指数，< 5）的受试者进行比较。在前瞻性分析中，呼吸暂停低通气指数为20或更高的睡眠呼吸障碍与未来4年内首次卒中风险增加相关（未校正比值比，4.31; 95%置信区间，1.31-14.15; p = 0.02）。然而，调整年龄，性别和体重指数后，比值比仍然升高，但不再显着（3.08; 95%置信区间，0.74-12.81; p = 0.12）。结论：这些数据表明，中度至重度睡眠呼吸障碍和流行性卒中之间有很强的相关性，独立于混杂因素。他们还提供了第一个前瞻性证据，表明睡眠呼吸障碍先于中风，并可能有助于中风的发展。
Rationale: Sleep-disordered breathing has been linked to stroke in previous studies. However, these studies either used surrogate markers of sleep-disordered breathing or could not, due to cross-sectional design, address the temporal relationship between sleep-disordered breathing and stroke.Objectives: To determine whether sleep-disordered breathing increases the risk for stroke.Methods: We performed cross-sectional and longitudinal analyses on 1,475 and 1,189 subjects, respectively, from the general population. Sleep-disordered breathing was defined by the apnea-hypopnea index (frequency of apneas and hypopneas per hour of sleep) obtained by attended polysomnography. The protocol, including polysomnography, risk factors for stroke, and a history of physician-diagnosed stroke, was repeated at 4-yr intervals.Measurements and Main Results: In the cross-sectional analysis, subjects with an apnea-hypopnea index of 20 or greater had increased odds for stroke (odds ratio, 4.33; 95% confidence interval, 1.32-14.24; p = 0.02) compared with those without sleep-disordered breathing (apnea-hypopnea index, < 5) after adjustment for known confounding factors. In the prospective analysis, sleep-disordered breathing with an apnea-hypopnea index of 20 or greater was associated with an increased risk of suffering a first-ever stroke over the next 4 yr (unadjusted odds ratio, 4.31; 95% confidence interval, 1.31-14.15; p = 0.02). However, after adjustment for age, sex, and body mass index, the odds ratio was still elevated, but was no longer significant (3.08; 95% confidence interval, 0.74-12.81; p = 0.12).Conclusions: These data demonstrate a strong association between moderate to severe sleep-disordered breathing and prevalent stroke, independent of confounding factors. They also provide the first prospective evidence that sleep-disordered breathing precedes stroke and may contribute to the development of stroke.