Sleep-disordered breathing and cardiovascular disease - An outcome-based definition of hypopneas
Sleep-disordered breathing and cardiovascular disease - An outcome-based definition of hypopneas
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DOI：
10.1164/rccm.200712-1884oc
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发表时间：
2008-05-15
影响因子：
24.7
通讯作者：
Sanders, Mark H.
中科院分区：
文献类型：
--
作者：
Punjabi, Naresh M.;Newman, Anne B.;Sanders, Mark H.
基本原理：关于睡眠呼吸障碍后果的流行病学研究总是使用呼吸暂停低通气指数作为疾病严重程度的主要衡量标准。虽然呼吸不足构成了大多数的呼吸紊乱事件，显着的争议仍然是最好的标准来定义这些events.Objectives：目前的调查旨在评估最合适的定义为呼吸不足，这将是最好的相关性与心血管diseases.Methods：一个社区样本的中年和老年人被招募的睡眠心脏健康研究的一部分。进行全蒙太奇多导睡眠描记术，并使用不同的氧合血红蛋白去饱和阈值（伴或不伴觉醒）定义呼吸不足。根据自我报告评估心血管疾病的患病率。Logistic回归分析用于描述呼吸不足指数与心血管疾病患病率之间的独立相关性。使用6，106名具有完整心血管疾病状态和多导睡眠图数据的成年人样本，目前的研究发现，与氧合血红蛋白去饱和度4%或以上相关的呼吸不足与流行的心血管疾病相关，独立于混杂协变量。使用4%去饱和标准，调整后的呼吸不足指数四分位数的普遍比值比如下：1.00（7.69起事件/h）。低于4%的氧合血红蛋白去饱和或存在觉醒的基础上呼吸不足的措施没有表现出与心血管疾病。结论：呼吸不足包括一个显着的组成部分，在一般社区的睡眠呼吸障碍。通过改变定义呼吸不足的标准，这项研究表明，呼吸不足与至少4%的去饱和度是独立相关的心血管疾病。相反，心血管疾病与轻度去饱和或觉醒相关的低血压之间没有观察到相关性。
Rationale: Epidemiologic studies on the consequences of sleep-disordered breathing invariably use the apnea-hypopnea index as the primary measure of disease severity. Although hypopneas constitute a majority of disordered breathing events, significant controversy remains about the best criteria used to define these events.Objectives: The current investigation sought to assess the most appropriate definition for hypopneas that would be best correlated with cardiovascular disease.Methods: A community sample of middle-aged and older adults was recruited as part of the Sleep Heart Health Study. Full-montage polysomnography was conducted and hypopneas were defined using different thresholds of oxyhemoglobin desaturation with and without arousals. Prevalent cardiovascular disease was assessed based on self-report. Logistic regression analysis was used to characterize the independent association between the hypopnea index and prevalent cardiovascular disease.Measurements and Main Results: Using a sample of 6,106 adults with complete data on cardiovascular disease status and polysomnography, the current study found that hypopneas associated with an oxyhemoglobin desaturation of 4% or more were associated with prevalent cardiovascular disease independent of confounding covariates. The adjusted prevalent odds ratios for quartiles of the hypopnea index using a 4% desaturation criterion were as follows: 1.00 (7.69 events/h). Hypopnea measures based on less than 4% oxyhemoglobin desaturation or presence of arousals showed no association with cardiovascular disease.Conclusions: Hypopneas comprise a significant component of sleep-disordered breathing in the general community. By varying the criteria for defining hypopneas, this study demonstrates that hypopneas with a desaturation of at least 4% are independently associated with cardiovascular disease. In contrast, no association was observed between cardiovascular disease and hypopreas associated with milder desaturations or arousals.