Sleep Apnea-Specific Hypoxic Burden, Symptom Subtypes, and Risk of Cardiovascular Events and All-Cause Mortality
Sleep Apnea-Specific Hypoxic Burden, Symptom Subtypes, and Risk of Cardiovascular Events and All-Cause Mortality
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DOI：
10.1164/rccm.202105-1274oc
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发表时间：
2022-01-01
影响因子：
24.7
通讯作者：
Gagnadoux, Frederic
中科院分区：
文献类型：
--
作者：
Trzepizur, Wojciech;Blanchard, Margaux;Gagnadoux, Frederic
理由：基于人群的队列数据表明，症状亚型和阻塞性睡眠呼吸暂停 (OSA) 特异性低氧负担 (HB) 有助于更好地识别具有高心血管 (CV) 风险的 OSA 患者。目的：我们旨在评估这些新标志物是否与临床环境中主要不良 CV 事件 (MACE) 的风险相关。方法：将卢瓦尔河地区队列的数据与健康管理数据联系起来，以确定 MACE 的发生（综合结果包括新诊断的 OSA 且无明显心血管疾病的患者的全因死亡率、急性心肌梗死、中风和计划外冠状动脉血运重建）。潜在类别分析用于根据八个临床相关变量来识别亚型。 HB 定义为呼吸事件相关去饱和曲线下的总面积。使用 Cox 比例风险模型评估症状亚型和 HB 与 MACE 的关联。测量和主要结果：确定了四种症状亚型（症状轻微 [22.0%]、睡眠不安 [17.5%]、过度困倦 [49.8%] 和中度困倦 [10.6%]）。中位随访 78 个月（四分位数范围，52-109）后，5,358 名患者中有 592 名（11.05%）经历了 MACE。在完全调整的模型中，HB 和通过睡眠时间和氧饱和度评估的整体夜间低氧血症，90% 是 MACE 的唯一预测因子（风险比，1.21；95% 置信区间，1.07-1.38；风险比，1.34；95% 置信区间，1.16-1.55）。对于年轻患者和女性，这种关联似乎更强。结论：在临床环境中，表现出 OSA 特异性 HB 升高的 OSA 患者发生心血管事件和全因死亡率的风险较高。调整混杂因素后，症状亚型与 MACE 无关。
Rationale: Data from population-based cohorts suggest that symptom subtypes and obstructive sleep apnea (OSA)-specific hypoxic burden (HB) could help to better identify patients with OSA at high cardiovascular (CV) risk.Objectives: We aimed to evaluate whether those new markers are associated with the risk of major adverse CV events (MACE) in clinical setting.Methods: Data from the Pays de la Loire cohort were linked to health administrative data to identify the occurrence of MACE (a composite outcome including all-cause mortality, acute myocardial infarction, stroke, and unplanned coronary revascularization) in patients with newly diagnosed OSA and no overt CV disease. Latent class analysis was used to identify subtypes based on eight clinically relevant variables. HB was defined as the total area under the respiratory event-related desaturation curve. Cox proportional hazards models were used to evaluate the association of symptom subtypes and HB with MACE.Measurements and Main Results: Four symptom subtypes were identified (minimally symptomatic [22.0%], disturbed sleep [17.5%], excessively sleepy [49.8%], and moderately sleepy [10.6%]). After a median follow-up of 78 months (interquartile range, 52-109), 592 (11.05%) of 5,358 patients experienced MACE. In a fully adjusted model, HB and overall nocturnal hypoxemia assessed by sleep time with oxygen saturation,90% were the only predictors ofMACE (hazard ratio, 1.21; 95% confidence interval, 1.07-1.38; and hazard ratio, 1.34; 95% confidence interval, 1.16-1.55, respectively). The association appeared stronger toward younger patients and women.Conclusion: In clinical setting, patients with OSA who demonstrate elevated OSA-specific HB are at higher risk of a CV event and all-cause mortality. Symptom subtypes were not associated with MACE after adjustment for confounders.