Effect of Sleep-Disordered Breathing on Appropriate Implantable Cardioverter-Defibrillator Therapy in Patients With Heart Failure: A Systematic Review and Meta-Analysis.
Effect of Sleep-Disordered Breathing on Appropriate Implantable Cardioverter-Defibrillator Therapy in Patients With Heart Failure: A Systematic Review and Meta-Analysis.
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DOI：
10.1161/circep.116.004609
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发表时间：
2017-03
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影响因子：
--
通讯作者：
Duval S
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作者：
Kwon Y;Koene RJ;Kwon O;Kealhofer JV;Adabag S;Duval S
心力衰竭和射血分数降低的患者发生恶性室性心律失常的风险增加。建议植入心律转复除颤器（ICD），以防止这些患者的心脏猝死。睡眠呼吸障碍（SDB）在这一人群中非常普遍，可能会影响致敏性。我们对评估SDB对ICD治疗影响的前瞻性研究进行了系统回顾和荟萃分析。在奥维德MEDLINE、EMBASE和Google Scholar数据库中识别了相关前瞻性研究。采用随机效应荟萃分析估计SDB与适当ICD治疗之间相关性的加权风险比。本分析纳入了9项前瞻性队列研究（n=1274）。52%的参与者存在SDB。SDB与适当ICD治疗的风险增加55%相关（45% vs 28%;风险比，1.55; 95%置信区间，1.32-1.83）。在基于SDB亚型的亚组分析中，中枢性（风险比，1.50; 95%置信区间，1.11-2.02）和阻塞性（风险比，1.43; 95%置信区间，1.01-2.03）睡眠呼吸暂停的风险较高。SDB与心力衰竭和射血分数降低患者适当ICD治疗的风险增加相关。
Patients with heart failure and reduced ejection fraction are at increased risk of malignant ventricular arrhythmias. Implantable cardioverter-defibrillator (ICD) is recommended to prevent sudden cardiac death in some of these patients. Sleep-disordered breathing (SDB) is highly prevalent in this population and may impact arrhythmogenicity. We performed a systematic review and meta-analysis of prospective studies that assessed the impact of SDB on ICD therapy. Relevant prospective studies were identified in the Ovid MEDLINE, EMBASE, and Google Scholar databases. Weighted risk ratios of the association between SDB and appropriate ICD therapies were estimated using random effects meta-analysis. Nine prospective cohort studies (n=1274) were included in this analysis. SDB was present in 52% of the participants. SDB was associated with a 55% higher risk of appropriate ICD therapies (45% versus 28%; risk ratio, 1.55; 95% confidence interval, 1.32–1.83). In a subgroup analysis based on the subtypes of SDB, the risk was higher in both central (risk ratio, 1.50; 95% confidence interval, 1.11–2.02) and obstructive (risk ratio, 1.43; 95% confidence interval, 1.01–2.03) sleep apnea. SDB is associated with an increased risk of appropriate ICD therapy in patients with heart failure and reduced ejection fraction.