The Sleep Apnea-Specific Hypoxic Burden Predicts Incident Heart Failure
The Sleep Apnea-Specific Hypoxic Burden Predicts Incident Heart Failure
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DOI：
10.1016/j.chest.2020.03.053
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发表时间：
2020-08-01
期刊：
影响因子：
9.6
通讯作者：
Redline, Susan
中科院分区：
文献类型：
--
作者：
Azarbarzin, Ali;Sands, Scott A.;Redline, Susan
背景技术背景：心力衰竭（HF）是发病率和死亡率的主要原因，尽管它与睡眠呼吸暂停有关，但与发病率最密切相关的生理应激源尚不清楚。我们在两个独立的队列研究中测试了睡眠呼吸暂停特异性缺氧负荷（SASHB）是否能预测HF事件。研究问题：与呼吸暂停低通气指数（AHI）相比，睡眠呼吸暂停特异性缺氧负荷如何预测HF事件？研究设计和方法：这些样本来自两项队列研究：睡眠心脏健康研究（SHHS），其中包括4，881名中年和老年人（54.4%女性），年龄63.6 +/-11.1岁;老年男性睡眠障碍结局（MrOS），其中包括2，653名男性，年龄76.2 +/-5.4岁。我们将SASHB计算为事件前基线的去饱和曲线下的睡眠呼吸暂停特异性面积。我们使用考克斯模型的事件HF估计调整后的风险比（HR）为自然对数转换SASHB和AHI调整多confounders.RESULTS：SASHB预测事件HF在两个队列的男性，而AHI没有。SHHS和MrOS组男性的校正HR（SASHB每增加1SD）分别为1.18（95% CI，1.02 - 1.37）和1.22（95% CI，1.02 - 1.45）。与SASHB的关联在低和高AHI水平的男性中观察到。解释：在男性中，睡眠呼吸暂停的缺氧负荷与人口统计学因素、吸烟和合并症后的HF事件相关。研究结果表明，量化一个容易测量的睡眠呼吸暂停相关缺氧指数可能有助于识别有心脏病风险的个体，同时也建议了干预目标。
BACKGROUND: Heart failure (HF) is a leading cause of morbidity and mortality and although it is linked to sleep apnea, which physiological stressors most strongly associate with incident disease is unclear. We tested whether sleep apnea-specific hypoxic burden (SASHB) predicts incident HF in two independent cohort studies.RESEARCH QUESTION: In comparison with apnea-hypopnea index (AHI), how does sleep apnea-specific hypoxic burden predict incident HF?STUDY DESIGN AND METHODS: The samples were derived from two cohort studies: The Sleep Heart Health Study (SHHS), which included 4,881 middle-aged and older adults (54.4% women), age 63.6 +/- 11.1 years; and the Outcomes of Sleep Disorders in Older Men (MrOS), which included 2,653 men, age 76.2 +/- 5.4 years. We computed SASHB as the sleep apnea-specific area under the desaturation curve from pre-event baseline. We used Cox models for incident HF to estimate the adjusted hazard ratios (HRs) for natural log transformed SASHB and AHI adjusting for multiple confounders.RESULTS: The SASHB predicted incident HF in men in both cohorts, whereas AHI did not. Men in SHHS and MrOS had adjusted HRs (per 1SD increase in SASHB) of 1.18 (95% CI, 1.02-1.37) and 1.22 (95% CI, 1.02-1.45), respectively. Associations with SASHB were observed in men with both low and high AHI levels. Associations were not significant in women.INTERPRETATION: In men, the hypoxic burden of sleep apnea was associated with incident HF after accounting for demographic factors, smoking, and co-morbidities. The findings Suggest that quantification of an easily measured index of sleep apnea-related hypoxias may be useful for identifying individuals at risk for heart disease, while also suggesting targets for intervention.