Obstructive Sleep Apnea-Hypopnea and Incident Stroke The Sleep Heart Health Study
Obstructive Sleep Apnea-Hypopnea and Incident Stroke The Sleep Heart Health Study
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DOI：
10.1164/rccm.200911-1746oc
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发表时间：
2010-07-01
影响因子：
24.7
通讯作者：
Punjabi, Naresh M.
中科院分区：
文献类型：
--
作者：
Redline, Susan;Yenokyan, Gayane;Punjabi, Naresh M.
基本原理虽然阻塞性睡眠呼吸暂停与增加高血压风险和促动脉粥样硬化的生理紊乱有关，但尚不确定睡眠呼吸暂停是否与普通人群中风风险增加有关。目的：在广泛的睡眠呼吸暂停人群中，量化缺血性中风伴睡眠呼吸暂停的发病率。方法：在1995年至1998年的纵向队列研究中进行了基线多导睡眠描记术。主要暴露是阻塞性呼吸暂停低通气指数（OAHI）和结果是缺血性stroke. Measures和主要结果：共有5,422名参与者在基线检查时没有中风史，并且未接受睡眠呼吸暂停治疗，平均随访时间为8.7年。观察到193例缺血性卒中。在协变量校正的考克斯比例风险模型中，在男性中观察到缺血性卒中与OAHI之间存在显著的正相关性（线性趋势的P值：P = 0.016）。ANI最高四分位数（>19）的男性校正后的风险比为2.86（95%置信区间，1.1-7.4）。在轻度至中度范围内（OAHI，5-25），AN每增加一个单位！在男性中，估计中风风险增加6%（95%置信区间，2-10%）。在女性中，卒中与OAHI四分位数无显著相关性，但OAHI大于25时观察到风险增加。结论：在社区居住的轻度至中度睡眠呼吸暂停男性中，缺血性卒中与OAHI之间的强校正相关性表明，这是未来卒中预防试验的适当目标。
Rationale Although obstructive sleep apnea is associated with physiological perturbations that increase risk of hypertension and are proatherogenic, it is uncertain whether sleep apnea is associated with increased stroke risk in the general population.Objectives: To quantify the incidence of ischemic stroke with sleep apnea in a community-based sample of men and women across a wide range of sleep apnea.Methods: Baseline polysomnography was performed between 1995 and 1998 in a longitudinal cohort study. The primary exposure was the obstructive apnea hypopnea index (OAHI) and outcome was incident ischemic stroke.Measurements and Main Results: A total of 5,422 participants without a history of stroke at the baseline examination and untreated for sleep apnea were followed for a median of 8.7 years. One hundred ninety-three ischemic strokes were observed. In covariate-adjusted Cox proportional hazard models, a significant positive association between ischemic stroke and OAHI was observed in men (P value for linear trend: P = 0.016). Men in the highest ANI quartile (>19) had an adjusted hazard ratio of 2.86 (95% confidence interval, 1.1-7.4). In the mild to moderate range (OAHI, 5-25), each one-unit increase in AN! in men was estimated to increase stroke risk by 6% (95% confidence interval, 2-10%). In women, stroke was not significantly associated with OAHI quartiles, but increased risk was observed at an OAHI greater than 25.Conclusions: The strong adjusted association between ischemic stroke and OAHI in community-dwelling men with mild to moderate sleep apnea suggests that this is an appropriate target for future stroke prevention trials.