Sleep apnea is a stronger predictor for coronary heart disease than traditional risk factors
Sleep apnea is a stronger predictor for coronary heart disease than traditional risk factors
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DOI：
10.1007/s11325-011-0559-0
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发表时间：
2012-09-01
影响因子：
2.5
通讯作者：
Goncalves Bos, Angelo Jose
中科院分区：
文献类型：
--
作者：
Martinez, Denis;Klein, Cristini;Goncalves Bos, Angelo Jose
睡眠呼吸暂停（SA）可能与冠状动脉疾病（CAD）有关。这两种情况有相似的风险因素，混淆了分析。在成人人群中，即使没有症状或疑似心脏疾病，也要常规检查血脂。然而，SA，仍然未被诊断，即使在明确的临床表现的存在下，本研究的目的是验证SA和CAD之间的关联，调整常见的CAD危险因素。SA的严重程度由呼吸暂停低通气指数（AHI）确定。我们测量了经典的CAD危险因素：空腹血糖;总胆固醇、HDL和LDL胆固醇;甘油三酯;尿酸和高敏C反应蛋白。我们排除了年龄大于65岁、体重指数大于40 kg/m2、有糖尿病和过去一年有吸烟史的患者，在纳入的55例患者中，28例AHI > 14，显示CAD的优势比为8.7。无CAD患者（n = 29）和CAD患者（n = 26）的AHI分别为每小时11 +/- 11和23 +/- 14（P = 0.001）。在控制所有上述危险因素的二元logistic回归预测CAD中，进入逐步模型的唯一变量是AHI（作为连续变量或分类变量）和尿酸。在没有吸烟者，病态肥胖或糖尿病患者的样本中，AHI是CAD的主要预测因子。SA应整合在临床研究中常规评估的一组危险因素，以进行冠状动脉疾病风险分层。
Sleep apnea (SA) may be linked to coronary artery disease (CAD). Both conditions have similar risk factors, confounding the analyses. Investigation of the lipid profile is routine in the adult population, even without symptoms or suspected cardiac ailment. SA, however, remains underdiagnosed even in the presence of unambiguous clinical manifestations.The aim of this study was to verify the association between SA and CAD, adjusting for usual CAD risk factors.Patients who underwent diagnostic or therapeutic coronariography and portable type III polysomnography were studied. The severity of SA was determined by the apnea-hypopnea index (AHI). We measured classic CAD risk factors: fasting glucose; total, HDL, and LDL cholesterols; triglycerides; uric acid, and high-sensitivity C-reactive protein. We excluded patients older than 65 years, with body mass index higher than 40 kg/m(2), with diabetes, and with history of smoking in the last year.Of 55 included patients, 28 had AHI > 14, showing an odds ratio of 8.7 for CAD. Patients without (n = 29) and with CAD (n = 26), showed AHI of, respectively, 11 +/- 11 and 23 +/- 14 per hour (P = 0.001). In a binary logistic regression to predict CAD, controlling for all the above risk factors, the only variables entered in the stepwise model were AHI (either as continuous or categorical variable) and uric acid.In a sample without smokers, morbidly obese, or diabetic patients, AHI is the main predictor of CAD. SA should integrate the set of risk factors routinely assessed in clinical investigation for coronary disease risk stratification.