Symptom Subtypes of Obstructive Sleep Apnea Predict Incidence of Cardiovascular Outcomes
Symptom Subtypes of Obstructive Sleep Apnea Predict Incidence of Cardiovascular Outcomes
复制标题
DOI：
10.1164/rccm.201808-1509oc
复制
发表时间：
2019-08-15
影响因子：
24.7
通讯作者：
Pack, Allan I.
中科院分区：
文献类型：
--
作者：
Mazzotti, Diego R.;Keenan, Brendan T.;Pack, Allan I.
理由：在临床和人群样本中描述了阻塞性睡眠呼吸暂停（OSA）患者的症状亚型。目前尚不清楚这些亚型是否有不同的心血管后果。目的：研究睡眠心脏健康研究中OSA症状亚型的特征，并评估其与流行和发病率心血管疾病的关系。方法：选取1207例OSA（呼吸暂停-低通气指数>= 15事件/h）患者的数据，采用潜在分类分析评估症状亚型的存在性。使用logistic回归评估亚型与总体心血管疾病及其组成部分（冠心病、心力衰竭和中风）患病率之间的关联。Kaplan-Meier生存分析和Cox比例风险模型用于评估亚型是否与事件事件相关，包括心血管死亡率。测量结果和主要结果：共发现4种症状亚型（睡眠不安[12.2%]、轻度症状[32.6%]、极度困倦[16.7%]和中度困倦[38.5%]），与既往研究相似。在调整后的模型中，虽然没有发现与普遍心血管疾病的显著关联，但与其他亚型相比，过度困倦亚型与普遍心力衰竭的风险增加了三倍以上。症状亚型还与心血管疾病（P < 0.001）、冠心病（P = 0.015）和心力衰竭（P = 0.018）相关，与其他亚型相比，过度困倦再次显示出增加的风险（危险比，1.7-2.4）。与没有OSA（呼吸暂停-低通气指数< 5）的个体相比，过度嗜睡亚型患者的心血管事件发生率显著增加。结论：OSA症状亚型具有可重复性并与心血管风险相关，为其临床相关性提供了重要证据。
Rationale: Symptom subtypes have been described in clinical and population samples of patients with obstructive sleep apnea (OSA). It is unclear whether these subtypes have different cardiovascular consequences.Objectives: To characterize OSA symptom subtypes and assess their association with prevalent and incident cardiovascular disease in the Sleep Heart Health Study.Methods: Data from 1,207 patients with OSA (apnea-hypopnea index >= 15 events/h) were used to evaluate the existence of symptom subtypes using latent class analysis. Associations between subtypes and prevalence of overall cardiovascular disease and its components (coronary heart disease, heart failure, and stroke) were assessed using logistic regression. Kaplan-Meier survival analysis and Cox proportional hazards models were used to evaluate whether subtypes were associated with incident events, including cardiovascular mortality.Measurements and Main Results: Four symptom subtypes were identified (disturbed sleep [12.2%], minimally symptomatic [32.6%], excessively sleepy [16.7%], and moderately sleepy [38.5%]), similar to prior studies. In adjusted models, although no significant associations with prevalent cardiovascular disease were found, the excessively sleepy subtype was associated with more than threefold increased risk of prevalent heart failure compared with each of the other subtypes. Symptom subtype was also associated with incident cardiovascular disease (P < 0.001), coronary heart disease (P = 0.015), and heart failure (P = 0.018), with the excessively sleepy again demonstrating increased risk (hazard ratios, 1.7-2.4) compared with other subtypes. When compared with individuals without OSA (apnea-hypopnea index < 5), significantly increased risk for prevalent and incident cardiovascular events was observed mostly for patients in the excessively sleepy subtype.Conclusions: OSA symptom subtypes are reproducible and associated with cardiovascular risk, providing important evidence of their clinical relevance.