Nocturnal Arrhythmias across a spectrum of obstructive and central sleep-disordered breathing in older men: outcomes of sleep disorders in older men (MrOS sleep) study.
Nocturnal Arrhythmias across a spectrum of obstructive and central sleep-disordered breathing in older men: outcomes of sleep disorders in older men (MrOS sleep) study.
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DOI：
10.1001/archinternmed.2009.138
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发表时间：
2009-06-22
影响因子：
--
通讯作者：
Redline, Susan
中科院分区：
文献类型：
--
作者：
Mehra, Reena;Stone, Katie L.;Varosy, Paul D.;Hoffman, Andrew R.;Marcus, Gregory M.;Blackwell, Terri;Ibrahim, Osama A.;Salem, Rawan;Redline, Susan
心律失常的发生率随着年龄的增长而增加，并可能与临床显著的发病率相关。我们研究了老年男性睡眠呼吸障碍（SDB）与夜间心房颤动或扑动（AF）和复杂心室异位（CVE）之间的关系。在老年男性睡眠障碍结果研究中，共有2911名参与者接受了无人看管的多导睡眠描记术。通过对多导睡眠图数据的心电图特异性分析来确定夜间房颤和CVE。暴露是(1)SDB由呼吸障碍指数（RDI）四分位数（包括所有呼吸暂停和呼吸不足的主要指数）定义，辅助定义包括(2)阻塞性事件，阻塞性睡眠呼吸暂停（OSA；阻塞性呼吸暂停低通气指数四分位数），或(3)中枢事件，中枢性睡眠呼吸暂停（CSA；中枢呼吸暂停指数类别），以及(4)缺氧（动脉氧饱和度<90%的睡眠时间百分比）。进行多变量logistic回归分析。增加的RDI四分位数与AF和CVE的几率增加相关（趋势P值）。分别为0.01和<.001)。与最低四分位数相比，最高RDI四分位数与AF（比值比[OR]， 2.15； 95%可信区间[CI]， 1.19-3.89）和CVE （OR, 1.43; 95% CI, 1.12-1.82）的几率增加相关。OSA四分位数的增加与CVE的增加显著相关（P值为趋势，）。中枢性睡眠呼吸暂停与房颤（OR, 2.69; 95%CI, 1.61-4.47）的相关性高于CVE （OR, 1.27; 95%CI, 0.97-1.66）。缺氧水平与CVE相关（P值为趋势值，< 0.001）；与最低四分位数相比，最高缺氧组的CVE发生率增加（OR, 1.62; 95% CI, 1.23-2.14）。在这个较大的老年男性队列中，SDB严重程度的增加与AF和CVE的发生率逐渐增加相关。当SDB以中枢性或阻塞性亚型为特征时，CVE与OSA和缺氧的相关性最强，而AF与CSA的相关性最强，提示不同的睡眠相关应激可能与老年男性心房和室性心律失常有关。
Rates of cardiac arrhythmias increase with age and may be associated with clinically significant morbidity. We studied the association between sleep-disordered breathing (SDB) with nocturnal atrial fibrillation or flutter (AF) and complex ventricular ectopy (CVE) in older men. A total of 2911 participants in the Outcomes of Sleep Disorders in Older Men Study underwent unattended polysomnography. Nocturnal AF and CVE were ascertained by electrocardiogram-specific analysis of the polysomnographic data. Exposures were (1) SDB defined by respiratory disturbance index (RDI) quartile (a major index including all apneas and hypopneas), and ancillary definitions incorporating (2) obstructive events, obstructive sleep apnea (OSA; Obstructive Apnea Hypopnea Index quartile), or (3) central events, central sleep apnea (CSA; Central Apnea Index category), and (4) hypoxia (percentage of sleep time with <90% arterial oxygen percent saturation). Multivariable logistic regression analyses were performed. An increasing RDI quartile was associated with increased odds of AF and CVE (P values for trend, .01 and <.001, respectively). The highest RDI quartile was associated with increased odds of AF (odds ratio [OR], 2.15; 95% confidence interval [CI], 1.19–3.89) and CVE (OR, 1.43; 95% CI, 1.12–1.82) compared with the lowest quartile. An increasing OSA quartile was significantly associated with increasing CVE (P value for trend, .01) but not AF. Central sleep apnea was more strongly associated with AF (OR, 2.69; 95%CI, 1.61–4.47) than CVE (OR, 1.27; 95% CI, 0.97–1.66). Hypoxia level was associated with CVE (P value for trend, <.001); those in the highest hypoxia category had an increased odds of CVE (OR, 1.62; 95% CI, 1.23–2.14) compared with the lowest quartile. In this large cohort of older men, increasing severity of SDB was associated with a progressive increase in odds of AF and CVE. When SDB was characterized according to central or obstructive subtypes, CVE was associated most strongly with OSA and hypoxia, whereas AF was most strongly associated with CSA, suggesting that different sleep-related stresses may contribute to atrial and ventricular arrhythmogenesis in older men.
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DOI：
10.1016/s0022-2828(86)80432-1
发表时间：
1986-12-01
影响因子：
5
作者：
ADAMANTIDIS, MM;CARON, JF;DUPUIS, BA
通讯作者：
DUPUIS, BA
影响因子：
2.2
作者：
Orwoll, E;Blank, JB;Stone, K
通讯作者：
Stone, K
影响因子：
37.8
作者：
Javaheri, S
通讯作者：
Javaheri, S
影响因子：
158.5
作者：
Gami, AS;Howard, DE;Somers, VK
通讯作者：
Somers, VK
DOI：
10.1164/ajrccm.153.1.8542128
发表时间：
1996-01-01
影响因子：
24.7
作者：
Hanly, PJ;ZuberiKhokhar, NS
通讯作者：
ZuberiKhokhar, NS