Increased Incidence of Stroke, but Not Coronary Heart Disease, in Elderly Patients With Sleep Apnea Role of Continuous Positive Airway Pressure Treatment
Increased Incidence of Stroke, but Not Coronary Heart Disease, in Elderly Patients With Sleep Apnea Role of Continuous Positive Airway Pressure Treatment
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DOI：
10.1161/strokeaha.118.023353
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发表时间：
2019-02-01
期刊：
影响因子：
8.3
通讯作者：
Martinez-Garcia, Miguel A.
中科院分区：
文献类型：
--
作者：
Catalan-Serra, Pablo;Campos-Rodriguez, Francisco;Martinez-Garcia, Miguel A.
背景和目的：年龄对阻塞性睡眠呼吸暂停(OSA)和硬性心血管事件发生率之间的关系的影响仍然存在争议。我们试图在一大群老年患者中分析OSA与中风和冠心病发病率的关系，并调查持续气道正压(CPAP)治疗在这些相关性中的作用。方法-对西班牙两所大学医院65年来因怀疑OSA而进行的前瞻性观察研究进行事后分析。呼吸暂停低通气指数(AHI)=15的患者分为未治疗(未开CPAP处方或依从性=30)和接受CPAP治疗(AHI和GT；=15，CPAP依从性=4小时/天)。结果：859例和794例老年患者分别进入卒中和冠心病分析。中位(四分位数范围)随访时间分别为72(50-88.5)个月和71(51.5-89)个月。与对照组相比，未治疗的重度OSA组、CPAP治疗组和轻中度OSA组发生卒中的完全调整风险比分别为3.42(95%CI，1.37~8.52)、1.02(95%CI，0.41~2.56)和1.76(95%CI，0.62~4.97)。结论：未经治疗的重度阻塞性睡眠呼吸暂停老年患者卒中的发生率增加，但冠心病的发生率没有增加。适当的CPAP治疗可能会降低这种风险。
Background and Purpose-The influence of age on the relationship between obstructive sleep apnea (OSA) and the incidence of hard cardiovascular events remains controversial. We sought to analyze the relationship between OSA and the incidence of stroke and coronary heart disease in a large cohort of elderly patients, as well as to investigate the role of continuous positive airway pressure (CPAP) treatment in these associations.Methods-Post hoc analysis of a prospective observational study of consecutive patients >= 65 years studied for OSA suspicion at 2 Spanish University Hospitals. Patients with an apnea-hypopnea index (AHI) = 15 and classified as untreated (CPAP not prescribed or compliance = 30), and CPAP-treated (AHI >= 15 and CPAP compliance >= 4 hours/day).Results-859 and 794 elderly patients were included in the stroke and coronary heart disease analyses, respectively. The median (interquartile range) follow-up was 72 (50-88.5) and 71 (51.5-89) months, respectively. Compared with the reference group, the fully adjusted hazard ratios for the incidence of stroke were 3.42 (95% CI, 1.37-8.52), 1.02 (95% CI, 0.41-2.56), and 1.76 (95% CI, 0.62-4.97) for the untreated severe OSA group, CPAP-treated group, and untreated mild-moderate OSA group, respectively. No associations were shown between any of the different OSA groups and coronary heart disease incidence.Conclusions-The incidence of stroke, but not coronary heart disease, is increased in elderly patients with untreated severe OSA. Adequate CPAP treatment may reduce this risk.