The Impact of Obstructive Sleep Apnea on Aortic Disease in Marfan's Syndrome
The Impact of Obstructive Sleep Apnea on Aortic Disease in Marfan's Syndrome
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DOI：
10.1159/000340008
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发表时间：
2013-01-01
期刊：
影响因子：
3.7
通讯作者：
Stradling, John R.
中科院分区：
文献类型：
--
作者：
Kohler, Malcolm;Pitcher, Alex;Stradling, John R.
背景：主动脉夹层是马凡氏综合征的一种危及生命的表现。初步证据表明，阻塞性睡眠呼吸暂停（OSA）与马凡氏综合征的主动脉疾病有关。目的：探讨阻塞性睡眠呼吸暂停（OSA）对马凡氏综合征主动脉事件的影响。研究方法：在患有马凡氏综合征的患者中，在基线进行睡眠研究，并且OSA被定义为在床上每小时15次呼吸暂停/呼吸不足（A+H）事件。因进行性主动脉扩张而手术和因主动脉破裂而死亡被定义为“主动脉事件”。Kaplan-Meier生存分析用于比较OSA患者和非OSA患者的无事件生存率。采用考克斯回归模型探讨协变量对无事件生存期的影响。结果：44例患者（平均年龄37.4岁，30名女性）的数据可用于分析; 15例患者（34.1%）患有OSA。中位随访时间为29个月（四分位距24-36）。5例患者在随访时间内发生了主动脉事件。中位无事件生存期为51.6个月。OSA患者的无事件生存期显著短于无OSA患者（p = 0.012）。在单变量分析中，A+H与主动脉事件相关[风险比（HR）1.09，95%置信区间（CI）1.01-1.18，p = 0.023]。考虑到BMI和A+H之间的相互作用，A+ H的HR增加（HR 1.75，95% CI 1.003-3.048，p = 0.049）。当其他协变量被强制纳入多变量分析时，这种关联不再显著。结论：这些数据表明，与没有OSA的患者相比，马凡氏综合征和OSA患者的主动脉无事件生存期可能较短，但需要更多来自精心设计的研究的数据来证明这种关联。版权所有（C）2012 S. Karger AG，巴塞尔
Background: Aortic dissection is a life-threatening manifestation of Marfan's syndrome. Preliminary evidence suggests that obstructive sleep apnea (OSA) is associated with aortic disease in Marfan's syndrome. Objectives: To study the effect of OSA on aortic events in Marfan's syndrome. Methods: In patients with Marfan's syndrome, a sleep study was performed at baseline and OSA was defined as 1 5 events of apnea/hypopnea (A+H) per hour in bed. Operation because of progressive aortic dilatation and death because of aortic rupture were defined as 'aortic events'. Kaplan-Meier survival analyses were used to compare event-free survival in patients with and without OSA. Cox regression models were used to explore the effects of covariates on event-free survival. Results: Data from 44 patients (mean age 37.4 years, 30 females) were available for analysis; 15 patients (34.1%) had OSA. The median follow-up time was 29 (interquartile range 24-36) months. Five patients had an aortic event within the follow-up time. Median event-free survival was 51.6 months. Event-free survival was significantly shorter in patients with OSA compared to patients without OSA (p = 0.012). In univariate analysis, A+H was associated with aortic events [hazard ratio (HR) 1.09, 95% confidence interval (CI) 1.01-1.18, p = 0.023]. Taking the interaction between BMI and A+H into account increased the HR for A+ H (HR 1.75, 95% CI 1.003-3.048, p = 0.049). This association was no longer significant when other covariates were forced into the multivariate analysis. Conclusions: These data suggest that aortic event-free survival may be shorter in patients with Marfan's syndrome and OSA compared to patients without OSA, but more data from well-designed studies are needed to prove this association. Copyright (C) 2012 S. Karger AG, Basel