Cardiovascular Mortality in Women With Obstructive Sleep Apnea With or Without Continuous Positive Airway Pressure Treatment A Cohort Study
Cardiovascular Mortality in Women With Obstructive Sleep Apnea With or Without Continuous Positive Airway Pressure Treatment A Cohort Study
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DOI：
10.7326/0003-4819-156-2-201201170-00006
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发表时间：
2012-01-17
影响因子：
39.2
通讯作者：
Montserrat, Josep M.
中科院分区：
文献类型：
--
作者：
Campos-Rodriguez, Francisco;Martinez-Garcia, Miguel A.;Montserrat, Josep M.
背景资料：阻塞性睡眠呼吸暂停（OSA）是男性心血管死亡的危险因素，但它是否也是女性心血管死亡的危险因素尚不清楚。目的：调查OSA是否是女性心血管死亡的危险因素，并评估持续气道正压通气（CPAP）治疗是否与风险变化相关。设计：前瞻性，观察性队列研究。设置：西班牙的2家睡眠诊所。患者：所有在1998年至2007年期间连续转诊的疑似OSA的女性。干预：每位女性都进行了诊断性睡眠研究。呼吸暂停低通气指数（AHI）小于10的女性为对照组。当AHI为10或更高时（分为轻度至中度[AHI为10至29]或重度[AHI >= 30]），阻塞性睡眠呼吸暂停被诊断为阻塞性睡眠呼吸暂停。OSA患者分为CPAP治疗（每天坚持≥ 4小时）或未治疗（每天坚持≥ 4小时或未开处方）。研究对象随访至2009年12月。测量结果：终点为心血管死亡。结果：共1116名女性参与研究（中位随访时间为72个月[四分位距为52 ~ 88个月]）。对照组的心血管死亡率较低（0.28/100人-年[95% CI，0.10 - 0.91]）（0.94/100人-年[CI，0.10至2.40]; P = 0.034）或重度OSA（3.71/100人-年[CI，0.09至7.50]; P < 0.001）。与对照组相比，完全校正的心血管死亡风险比为3.50（CI，1.23至9.98）对于未治疗的重度OSA组; 0.55 CPAP治疗的重度OSA组（CI，0.17 - 1.74）; 1.60（CI，0.52至4.90）未治疗的轻度至中度OSA组;和0.19 CPAP治疗的轻度至中度OSA组的CI为0.02至1.67。局限性：本研究为观察性研究，非随机研究，OSA通过2种不同的方法诊断。严重的阻塞性睡眠呼吸暂停与女性心血管死亡有关，充分的持续气道正压通气治疗可能会降低这种风险。
Background: Obstructive sleep apnea (OSA) is a risk factor for cardiovascular death in men, but whether it is also a risk factor in women is unknown.Objective: To investigate whether OSA is a risk factor for cardiovascular death in women and assess whether continuous positive airway pressure (CPAP) treatment is associated with a change in risk.Design: Prospective, observational cohort study.Setting: 2 sleep clinics in Spain.Patients: All women consecutively referred for suspected OSA between 1998 and 2007.Intervention: Every woman had a diagnostic sleep study. Women with an apnea-hypopnea index (AHI) less than 10 were the control group. Obstructive sleep apnea was diagnosed when the AHI was 10 or higher (classified as mild to moderate [AHI of 10 to 29] or severe [AHI >= 30]).Patients with OSA were classified as CPAP-treated (adherence >= 4 hours per day) or untreated (adherence >= 4 hours per day or not prescribed). Participants were followed until December 2009.Measurements: The end point was cardiovascular death.Results: 1116 women were studied (median follow-up, 72 months [interquartile range, 52 to 88 months]). The control group had a lower cardiovascular mortality rate (0.28 per 100 person-years [95% CI, 0.10 to 0.91]) than the untreated groups with mild to moderate OSA (0.94 per 100 person-years [CI, 0.10 to 2.40]; P = 0.034) or severe OSA (3.71 per 100 person-years [CI, 0.09 to 7.50]; P < 0.001). Compared with the control group, the fully adjusted hazard ratios for cardiovascular mortality were 3.50 (CI, 1.23 to 9.98) for the untreated, severe OSA group; 0.55 (CI, 0.17 to 1.74) for the CPAP-treated, severe OSA group; 1.60 (CI, 0.52 to 4.90) for the untreated, mild to moderate OSA group; and 0.19 (CI, 0.02 to 1.67) for the CPAP-treated, mild to moderate OSA group.Limitation: The study was observational and not randomized, and OSA was diagnosed by 2 different methods.Conclusion: Severe OSA is associated with cardiovascular death in women, and adequate CPAP treatment may reduce this risk.