Interactive associations of depression and sleep apnea with adverse clinical outcomes after acute myocardial infarction.
Interactive associations of depression and sleep apnea with adverse clinical outcomes after acute myocardial infarction.
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DOI：
10.1097/psy.0b013e31826d2c81
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发表时间：
2012-10
影响因子：
3.3
通讯作者：
Blumenthal JA
中科院分区：
文献类型：
--
作者：
Hayano J;Carney RM;Watanabe E;Kawai K;Kodama I;Stein PK;Watkins LL;Freedland KE;Blumenthal JA
抑郁和睡眠呼吸暂停（SA）在急性心肌梗死（AMI）后患者中很常见，两者都与不良结局的风险增加有关。我们检验了ami后患者抑郁和SA与预后之间存在相互作用的假设。参与者是337名抑郁症和379名非抑郁症ami后患者，他们参加了增强冠心病恢复（enrichment）临床试验的亚研究。通过一种检测心率循环变化的算法，从入口的动态心电图中识别SA。在中位随访25个月期间，43例（6.0%）患者死亡，83例（11.6%）患者死亡或复发性AMI。在94名同时患有抑郁症和SA的患者中，这些终点分别出现在20名（21.3%）和25名（26.6%）患者中，患病率分别是富集临床风险评分预测概率的6.9倍和3.9倍（两者均P < 0.001）。在单独抑郁、单独SA或两者都没有的患者中，频率与预测概率没有显著差异。虽然抑郁和SA都能预测死亡和联合终点，但我们通过SA的相互作用观察到抑郁（P = 0.03和0.02）。SA在抑郁症患者中独立预测这些终点（P < 0.001和P = 0.001），但在非抑郁症患者中不独立预测（P = 0.73和0.84）。同样，抑郁独立地预测了SA患者的这些终点（两者均P < 0.001），但非SA患者没有预测这些终点（P = 0.61和0.12）。CVHR评估的抑郁和SA合并与AMI后的长期不良临床结果相关。
Depression and sleep apnea (SA) are common among patients after acute myocardial infarction (AMI), and both are associated with increased risk for adverse outcomes. We tested the hypothesis that there is an interaction between depression and SA in relation to prognosis in post-AMI patients. Participants were 337 depressed and 379 nondepressed post-AMI patients who participated in a substudy of the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial. SA was identified from Holter ECG at the entry by an algorithm that detects cyclic variation of heart rate. During a median follow-up of 25 months, 43 (6.0%) of patients died and 83 (11.6%) either died or experienced a recurrent AMI. Among 94 patients with both depression and SA, these endpoints occurred in 20 (21.3%) and 25 (26.6%), the prevalence that was 6.9 and 3.9 times higher than predicted probabilities by ENRICHD clinical risk scores (P <.001 for both). In the patients with depression alone, SA alone, or neither, the frequencies did not differ significantly from the predicted probability. Although both depression and SA predicted death and the combined endpoint, we observed depression by SA interactions (P = .03 and .02). SA independently predicted these endpoints in depressed (P <.001 and P = .001), but not in nondepressed patients (P = .73 and .84). Similarly, depression independently predicted these endpoints in SA (P <.001 for both), but not in non-SA patients (P = .61 and .12). The combination of depression and SA estimated by CVHR is associated with long-term adverse clinical outcomes after AMI.