Day-night pattern of sudden death in obstructive sleep apnea
Day-night pattern of sudden death in obstructive sleep apnea
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DOI：
10.1056/nejmoa041832
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发表时间：
2005-03-24
影响因子：
158.5
通讯作者：
Somers, VK
中科院分区：
文献类型：
--
作者：
Gami, AS;Howard, DE;Somers, VK
背景：在一般人群中，心脏原因猝死的风险在早上6点到中午达到高峰，在午夜到早上6点达到最低点。阻塞性睡眠呼吸暂停非常普遍，与神经激素和电生理异常相关，可能会增加心脏原因猝死的风险，尤其是在睡眠期间。在一天中的四个时间段内，我们比较了阻塞性睡眠呼吸暂停患者和以下人群的心脏原因猝死率：无阻塞性睡眠呼吸暂停患者的猝死率，一般人群的猝死率，以及根据机会的预期。对于每个时间间隔，我们评估了平均呼吸暂停低通气指数和心源性猝死的相对风险。我们类似地分析了在与通常的睡眠-觉醒周期相关的三个时间间隔内由心脏原因引起的猝死。46%的阻塞性睡眠呼吸暂停患者发生心脏原因猝死，而无阻塞性睡眠呼吸暂停患者为21%（P=0.01），普通人群为16%（P= 0.001）。
BACKGROUND:The risk of sudden death from cardiac causes in the general population peaks from 6 a.m. to noon and has a nadir from midnight to 6 a.m. Obstructive sleep apnea is highly prevalent and associated with neurohormonal and electrophysiological abnormalities that may increase the risk of sudden death from cardiac causes, especially during sleep.METHODS:We reviewed polysomnograms and the death certificates of 112 Minnesota residents who had undergone polysomnography and had died suddenly from cardiac causes between July 1987 and July 2003. For four intervals of the day, we compared the rates of sudden death from cardiac causes among people with obstructive sleep apnea and the following: the rates among people without obstructive sleep apnea, the rates in the general population, and the expectations according to chance. For each interval, we assessed the median apnea-hypopnea index and the relative risk of sudden death from cardiac causes. We similarly analyzed sudden death from cardiac causes during three time intervals that correlate with usual sleep-wake cycles.RESULTS:From midnight to 6 a.m., sudden death from cardiac causes occurred in 46 percent of people with obstructive sleep apnea, as compared with 21 percent of people without obstructive sleep apnea (P=0.01), 16 percent of the general population (P