Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation
Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation
复制标题
DOI：
10.1016/j.jacc.2006.08.060
复制
发表时间：
2007-02-06
影响因子：
24
通讯作者：
Somers, Virend K.
中科院分区：
文献类型：
--
作者：
Gami, Apoor S.;Hodge, Dave O.;Somers, Virend K.
目的本研究旨在明确肥胖和阻塞性睡眠呼吸暂停(OSA)是否独立预测房颤/扑动(AF)的发生。背景肥胖是房颤的危险因素，而OSA在肥胖中非常普遍。阻塞性睡眠呼吸暂停与房颤相关，但目前尚不清楚阻塞性睡眠呼吸暂停是否能独立于肥胖预测新发房颤。方法我们对3,542名从1987年到2003年接受多导睡眠图初步诊断的奥姆斯特县成年人进行了回顾性队列研究。结果133名受试者发生房颤的累积概率为14%，95%可信区间为9%~19%。单变量预测因素有年龄、男性、高血压、冠状动脉疾病、心力衰竭、吸烟、体重指数、OSA(危险比2.18，95%可信区间1.34~3.54)和OSA严重程度的多项指标。在65岁的受试者中，发生房颤的独立预测因素是年龄、男性、冠状动脉疾病、体重指数(每1 kg/m(2)，危险比1.07，95%可信区间1.05~1.10)和夜间血氧饱和度降低(每0.5U对数变化，危险比3.29，95%可信区间1.35~8.04)。心力衰竭、肥胖和阻塞性睡眠呼吸暂停都不能预测65岁受试者房颤的发生。结论肥胖和夜间氧减饱和度是阻塞性睡眠呼吸暂停综合征的重要病理生理后果，是65岁患者发生房颤的独立危险因素。
Objectives This study sought to identify whether obesity and obstructive sleep apnea (OSA) independently predict incident atrial fibrillation/flutter (AF).Background Obesity is a risk factor for AF, and OSA is highly prevalent in obesity. Obstructive sleep apnea is associated with AF, but it is unknown whether OSA predicts new-onset AF independently of obesity.Methods We conducted a retrospective cohort study of 3,542 Olmsted County adults without past or current AF who were referred for an initial diagnostic polysomnogram from 1987 to 2003. New-onset AF was assessed and confirmed by electrocardiography during a mean follow-up of 4.7 years.Results Incident AF occurred in 133 subjects (cumulative probability 14%, 95% confidence interval [CI] 9% to 19%). Univariate predictors of AF were age, male gender, hypertension, coronary artery disease, heart failure, smoking, body mass index, OSA (hazard ratio 2.18, 95% CI 1.34 to 3.54) and multiple measures of OSA severity. In subjects < 65 years old, independent predictors of incident AF were age, male gender, coronary artery disease, body mass index (per 1 kg/m(2), hazard ratio 1.07, 95% CI 1.05 to 1.10), and the decrease in nocturnal oxygen saturation (per 0.5 U log change, hazard ratio 3.29, 95% CI 1.35 to 8.04). Heart failure, but neither obesity nor OSA, predicted incident AF in subjects >= 65 years of age.Conclusions Obesity and the magnitude of nocturnal oxygen desaturation, which is an important pathophysiological consequence of OSA, are independent risk factors for incident AF in individuals < 65 years of age.