Obstructive Sleep Apnea, Obesity, and the Development of Acute Respiratory Distress Syndrome
Obstructive Sleep Apnea, Obesity, and the Development of Acute Respiratory Distress Syndrome
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DOI：
10.5664/jcsm.3794
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发表时间：
2014-01-01
影响因子：
4.3
通讯作者：
Festic, Emir
中科院分区：
文献类型：
--
作者：
Karnatovskaia, Lioudmila V.;Lee, Augustine S.;Festic, Emir
背景资料：阻塞性睡眠呼吸暂停（OSA）可增加手术患者发生呼吸系统并发症和急性呼吸窘迫综合征（ARDS）的风险。OSA在肥胖个体中更为普遍;肥胖可诱发ARDS。假设：目前尚不清楚OSA是否独立地导致住院患者发生ARDS的风险。方法：这是一项预先计划的回顾性亚组分析，对前瞻性确定的5人队列进行分析，来自22家医院的584名患者，在住院时至少有一种ARDS风险因素，来自美国危重疾病和损伤试验组的试验，来验证肺损伤预测评分共有252名患者（4.5%）在住院时诊断为OSA;其中66%为肥胖。经多因素Logistic回归分析，OSA与ARDS的发生无显著相关性（OR = 0.65，95%CI = 0.32-1.22）。然而，体重指数（BMI）与随后的ARDS发展相关（OR = 1.02，95%CI = 1.00-1.04，p = 0.03）。OSA和BMI均不影响机械通气需求或mortals.Conclusions：OSA的既往诊断并不独立影响至少有一种易感条件的患者中ARDS的发展，也不影响机械通气或住院死亡率的需要。肥胖似乎独立增加ARDS的风险。
Background: Obstructive sleep apnea (OSA) may increase the risk of respiratory complications and acute respiratory distress syndrome (ARDS) among surgical patients. OSA is more prevalent among obese individuals; obesity can predispose to ARDS.Hypothesis: It is unclear whether OSA independently contributes towards the risk of ARDS among hospitalized patients.Methods: This is a pre-planned retrospective subgroup analysis of the prospectively identified cohort of 5,584 patients across 22 hospitals with at least one risk factor for ARDS at the time of hospitalization from a trial by the US Critical Illness and Injury Trials Group designed to validate the Lung Injury Prediction Score. A total of 252 patients (4.5%) had a diagnosis of OSA at the time of hospitalization; of those, 66% were obese. Following multivariate adjustment in the logistic regression model, there was no significant relationship between OSA and development of ARDS (OR = 0.65, 95%CI = 0.32-1.22). However, body mass index (BMI) was associated with subsequent ARDS development (OR = 1.02, 95%CI = 1.00-1.04, p = 0.03). Neither OSA nor BMI affected mechanical ventilation requirement or mortality.Conclusions: Prior diagnosis of OSA did not independently affect development of ARDS among patients with at least one predisposing condition, nor the need for mechanical ventilation or hospital mortality. Obesity appeared to independently increase the risk of ARDS.