Sleep-disordered breathing and mortality: a prospective cohort study.
Sleep-disordered breathing and mortality: a prospective cohort study.
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DOI：
10.1371/journal.pmed.1000132
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发表时间：
2009-08
期刊：
影响因子：
15.8
通讯作者：
Samet JM
中科院分区：
文献类型：
--
作者：
Punjabi NM;Caffo BS;Goodwin JL;Gottlieb DJ;Newman AB;O'Connor GT;Rapoport DM;Redline S;Resnick HE;Robbins JA;Shahar E;Unruh ML;Samet JM
Naresh Punjabi 及其同事对 6,441 名志愿者进行了平均 8.2 年的随访，发现睡眠呼吸障碍与死亡率独立相关，并确定了预测特征。睡眠呼吸障碍是一种常见病症，与高血压和心血管疾病等不良健康结果相关。本研究的总体目标是确定睡眠呼吸障碍及其间歇性低氧血症和反复觉醒的后遗症是否与 40 岁或以上成年人社区样本的死亡率相关。我们对参与睡眠心脏健康研究的 6,441 名男性和女性进行前瞻性研究，研究睡眠呼吸障碍是否与全因死亡风险增加相关。根据家庭多导睡眠图，通过呼吸暂停低通气指数（AHI）评估睡眠呼吸障碍。在调整年龄、性别、种族、吸烟状况、体重指数和流行医疗条件后，使用生存分析和比例风险回归模型来计算死亡率的风险比。该队列的平均随访期为 8.2 年，期间有 1,047 名参与者（587 名男性和 460 名女性）死亡。与无睡眠呼吸障碍患者（AHI：<5 次事件/小时）相比，轻度（AHI：5.0–14.9 事件/小时）、中度（AHI：15.0–29.9 事件/小时）和重度（AHI：≥30.0 事件/小时）睡眠呼吸障碍患者的全因死亡率完全调整后的风险比为 0.93（95% CI： 0.80–1.08), 分别为 1.17（95% CI：0.97–1.42）和 1.46（95% CI：1.14–1.86）。按性别和年龄进行的分层分析表明，40-70 岁男性中，与严重睡眠呼吸障碍相关的死亡风险增加具有统计学意义（风险比：2.09；95% CI：1.31-3.33）。与睡眠相关的间歇性低氧血症（而非睡眠碎片化）的测量结果与全因死亡率独立相关。与睡眠呼吸障碍相关的冠状动脉疾病相关死亡率表现出类似于全因死亡率的关联模式。睡眠呼吸障碍与全因死亡率相关，特别是冠状动脉疾病导致的死亡率，尤其是患有严重睡眠呼吸障碍的 40-70 岁男性。 请参阅本文后面的编辑摘要 大约十分之一的女性和四分之一的男性患有称为睡眠呼吸障碍的慢性疾病，尽管大多数人并没有意识到自己的问题。睡眠呼吸障碍最常见于中老年人，其特点是睡眠期间出现多次短暂（10 秒左右）的呼吸中断。这些中断通常发生在上呼吸道肌肉松弛导致气流减少、血液中的含氧量降低时，因此，受影响的人经常会因呼吸困难而从深度睡眠中醒来。睡眠呼吸障碍的症状包括打鼾和白天嗜睡。治疗方法包括改变生活方式，例如减肥（颈部多余脂肪会增加气道塌陷）和戒烟。受影响的人还可以使用特殊设备来防止仰卧睡觉，但对于严重的睡眠呼吸障碍，医生通常建议使用持续气道正压通气 (CPAP)，这是一种通过面罩对上呼吸道加压以保持其开放的机器。睡眠呼吸障碍是一种严重的疾病。它与多种不利的健康状况有关，包括冠状动脉疾病（供应心脏的血管变窄，可能导致心脏病发作）和可能影响个人驾驶能力的白天嗜睡。此外，一些临床和社区研究表明，睡眠障碍可能会增加一个人的死亡风险。然而，由于这些研究规模较小，而且往往未能考虑到影响个体死亡风险的其他条件和特征（“混杂因素”），因此它们提供的有关睡眠呼吸障碍与死亡风险之间潜在关联的信息不一致或不完整。在这项前瞻性队列研究（睡眠心脏健康研究的一部分，该研究正在研究睡眠呼吸障碍对心血管健康的影响）中，研究人员在大型社区成年人样本中研究了睡眠呼吸障碍是否与全因死亡率（任何原因导致的死亡）相关。前瞻性队列研究是指招募一组参与者，然后及时跟踪（在本例中为几年）以观察他们身上发生了什么。入组时，研究参与者（超过 6,000 名 40 岁或以上的人，其中没有人因睡眠呼吸障碍而接受治疗）接受了健康检查。还评估了他们的夜间呼吸、睡眠模式和血氧水平，这些数据用于计算每个参与者的呼吸暂停-呼吸不足指数（AHI）——每小时呼吸暂停和呼吸不足的次数。在研究随访期间，1,047 名参与者死亡。与没有睡眠障碍的参与者相比，在调整潜在的混杂因素后，患有严重睡眠呼吸障碍（AHI ≥30）的参与者因任何原因死亡的可能性大约是没有睡眠障碍的参与者的一倍半。患有轻度睡眠呼吸障碍的人死亡风险并没有统计学上显着增加。根据年龄和性别将参与者分为亚组后，40-70岁患有严重睡眠呼吸障碍的男性因任何原因死亡的风险在统计上增加（是没有睡眠呼吸障碍的相似年龄男性的两倍）。最后，男性因冠状动脉疾病死亡也与睡眠呼吸障碍有关，但女性则不然。这些研究结果表明，即使考虑到已知的混杂因素，睡眠呼吸障碍与全因死亡风险增加相关，特别是在 40-70 岁的男性中。他们还表明，死亡风险的增加与冠状动脉疾病特别相关，尽管需要进一步的研究来证实这一发现，因为它是基于对一小部分研究参与者的分析。尽管这项研究比之前对睡眠呼吸障碍与全因死亡率之间关系的调查规模要大得多，但它有一些局限性，包括依赖于单晚的测量来诊断睡眠呼吸障碍。然而，这些发现表明，现在应该开始临床试验来评估治疗是否可以降低似乎与这种常见疾病相关的死亡风险增加。请通过此摘要的在线版本访问这些网站：http://dx.doi.org/10.1371/journal.pmed.1000132。美国国家心肺和血液研究所提供有关睡眠呼吸障碍（睡眠呼吸暂停）的信息（包括视频）（英语和西班牙语） 英国国家卫生服务中心还为患者提供有关睡眠呼吸暂停的信息 MedlinePlus 提供有关睡眠呼吸障碍的更多信息和建议的链接（英语和西班牙语） 提供有关睡眠心脏健康研究的更多信息
In a cohort of 6,441 volunteers followed over an average of 8.2 years, Naresh Punjabi and colleagues find sleep-disordered breathing to be independently associated with mortality and identify predictive characteristics. Sleep-disordered breathing is a common condition associated with adverse health outcomes including hypertension and cardiovascular disease. The overall objective of this study was to determine whether sleep-disordered breathing and its sequelae of intermittent hypoxemia and recurrent arousals are associated with mortality in a community sample of adults aged 40 years or older. We prospectively examined whether sleep-disordered breathing was associated with an increased risk of death from any cause in 6,441 men and women participating in the Sleep Heart Health Study. Sleep-disordered breathing was assessed with the apnea–hypopnea index (AHI) based on an in-home polysomnogram. Survival analysis and proportional hazards regression models were used to calculate hazard ratios for mortality after adjusting for age, sex, race, smoking status, body mass index, and prevalent medical conditions. The average follow-up period for the cohort was 8.2 y during which 1,047 participants (587 men and 460 women) died. Compared to those without sleep-disordered breathing (AHI: <5 events/h), the fully adjusted hazard ratios for all-cause mortality in those with mild (AHI: 5.0–14.9 events/h), moderate (AHI: 15.0–29.9 events/h), and severe (AHI: ≥30.0 events/h) sleep-disordered breathing were 0.93 (95% CI: 0.80–1.08), 1.17 (95% CI: 0.97–1.42), and 1.46 (95% CI: 1.14–1.86), respectively. Stratified analyses by sex and age showed that the increased risk of death associated with severe sleep-disordered breathing was statistically significant in men aged 40–70 y (hazard ratio: 2.09; 95% CI: 1.31–3.33). Measures of sleep-related intermittent hypoxemia, but not sleep fragmentation, were independently associated with all-cause mortality. Coronary artery disease–related mortality associated with sleep-disordered breathing showed a pattern of association similar to all-cause mortality. Sleep-disordered breathing is associated with all-cause mortality and specifically that due to coronary artery disease, particularly in men aged 40–70 y with severe sleep-disordered breathing. Please see later in the article for the Editors' Summary About 1 in 10 women and 1 in 4 men have a chronic condition called sleep-disordered breathing although most are unaware of their problem. Sleep-disordered breathing, which is commonest in middle-aged and elderly people, is characterized by numerous, brief (10 second or so) interruptions of breathing during sleep. These interruptions, which usually occur when relaxation of the upper airway muscles decreases airflow, lower the level of oxygen in the blood and, as a result, affected individuals are frequently aroused from deep sleep as they struggle to breathe. Symptoms of sleep-disordered breathing include loud snoring and daytime sleepiness. Treatments include lifestyle changes such as losing weight (excess fat around the neck increases airway collapse) and smoking cessation. Affected people can also use special devices to prevent them sleeping on their backs, but for severe sleep-disordered breathing, doctors often recommend continuous positive airway pressure (CPAP), a machine that pressurizes the upper airway through a face mask to keep it open. Sleep-disordered breathing is a serious condition. It is associated with several adverse health conditions including coronary artery disease (narrowing of the blood vessels that supply the heart, a condition that can cause a heart attack) and daytime sleepiness that can affect an individual's driving ability. In addition, several clinic- and community-based studies suggest that sleep-disordered sleeping may increase a person's risk of dying. However, because these studies have been small and have often failed to allow for other conditions and characteristics that affect an individual's risk of dying (“confounding factors”), they provide inconsistent or incomplete information about the potential association between sleep-disordered breathing and the risk of death. In this prospective cohort study (part of the Sleep Heart Health Study, which is researching the effects of sleep-disordered breathing on cardiovascular health), the researchers examine whether sleep-disordered breathing is associated with all-cause mortality (death from any cause) in a large community sample of adults. A prospective cohort study is one in which a group of participants is enrolled and then followed forward in time (in this case for several years) to see what happens to them. At enrollment, the study participants—more than 6,000 people aged 40 years or older, none of whom were being treated for sleep-disordered breathing—had a health examination. Their night-time breathing, sleep patterns, and blood oxygen levels were also assessed and these data used to calculate each participant's apnea-hypopnea index (AHI)—the number of apneas and hypopneas per hour. During the study follow-up period, 1,047 participants died. Compared to participants without sleep-disordered sleeping, participants with severe sleep-disordered breathing (an AHI of ≥30) were about one and a half times as likely to die from any cause after adjustment for potential confounding factors. People with milder sleep-disordered breathing did not have a statistically significant increased risk of dying. After dividing the participants into subgroups according to their age and sex, men aged 40–70 years with severe sleep-disordered breathing had a statistically increased risk of dying from any cause (twice the risk of men of a similar age without sleep-disordered breathing). Finally, death from coronary artery disease was also associated with sleep-disordered breathing in men but not in women. These findings indicate that sleep-disordered breathing is associated with an increased risk of all-cause mortality, particularly in men aged 40–70 years, even after allowing for known confounding factors. They also suggest that the increased risk of death is specifically associated with coronary artery disease although further studies are needed to confirm this finding because it was based on the analysis of a small subgroup of study participants. Although this study is much larger than previous investigations into the association between sleep-disordered breathing and all-cause mortality, it has several limitations including its reliance on a single night's measurements for the diagnosis of sleep-disordered breathing. Nevertheless, these findings suggest that clinical trials should now be started to assess whether treatment can reduce the increased risk of death that seems to be associated with this common disorder. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1000132. The US National Heart Lung and Blood Institute has information (including a video) about sleep-disordered breathing (sleep apnea) (in English and Spanish) The UK National Heath Service also provides information for patients about sleep apnea MedlinePlus provides links to further information and advice about sleep-disordered breathing (in English and Spanish) More information on the Sleep Heart Health Study is available
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影响因子：
10
作者：
Lindberg, E;Janson, C;Boman, G
通讯作者：
Boman, G
影响因子：
5
作者：
Punjabi, NM;Shahar, E;Resnick, HE
通讯作者：
Resnick, HE
影响因子：
9.6
作者：
HE, J;KRYGER, MH;ROTH, T
通讯作者：
ROTH, T
影响因子：
5.6
作者：
LAVIE, P;HERER, P;RUBIN, AHE
通讯作者：
RUBIN, AHE
影响因子：
9.6
作者：
PARTINEN, M;JAMIESON, A;GUILLEMINAULT, C
通讯作者：
GUILLEMINAULT, C