Prospective associations of sleep apnea, periodic limb movements, and plasma fibrinogen level
Prospective associations of sleep apnea, periodic limb movements, and plasma fibrinogen level
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DOI：
10.1007/s11325-020-02147-5
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发表时间：
2020-07-20
影响因子：
2.5
通讯作者：
Chin, Kazuo
中科院分区：
文献类型：
--
作者：
Murase, Kimihiko;Azuma, Masanori;Chin, Kazuo
目的我们以前的横断面研究表明，阻塞性睡眠呼吸暂停（OSA）患者经常出现睡眠期间的周期性肢体运动（PLMS），OSA和PLMS都与较高的血浆纤维蛋白原水平有关。我们探讨了这些因素之间的纵向关系。方法对333例经多导睡眠监测诊断为OSA的患者进行血浆纤维蛋白原测定。开始使用持续气道正压通气（CPAP）的患者在使用CPAP 3个月后接受随访多导睡眠图。他们被分为依从性好或依从性差的组（CPAP使用>= 4小时/夜的天数百分比分别为>= 70%或<70%）。比较两组治疗期间睡眠参数和血浆纤维蛋白原水平的变化。结果本组333例患者的横断面分析显示，纤维蛋白原水平与OSA和PLMS的严重程度相关。60例患者（27例依从性良好，33例依从性差）接受了随访多导睡眠描记术，被纳入纵向分析。从CPAP滴定到3个月随访，中位（四分位距）周期性肢体运动指数没有显著变化（依从性良好：10.5（0-23.8）至10.8（0-70.2）起事件/h，p = 0.21;依从性差：1.2（0-14.3）至0.8（0-15.7）起事件/h，p = 0.67）。然而，血浆纤维蛋白原水平仅在良好依从性组中显著降低（良好依从性：基线275 +/- 46至随访255 +/- 47 mg/dl，p < 0.01;不良依从性：277 +/- 52至284 +/- 70 mg/dl，p = 0.48）。结论这些结果不支持PLMS和OSA之间的纵向关联。然而，良好的CPAP依从性可以降低血浆纤维蛋白原水平，从而改善作为未来心血管事件风险因素的血浆纤维蛋白原升高。
Purpose Our previous cross-sectional study showed that periodic limb movements during sleep (PLMS) were frequently found in patients with obstructive sleep apnea (OSA) and that both OSA and PLMS were associated with higher plasma fibrinogen levels. We explored the longitudinal relationships among these factors. Methods Plasma fibrinogen levels were measured in 333 consecutive patients who underwent polysomnography to diagnose OSA. Patients who initiated continuous positive airway pressure (CPAP) underwent follow-up polysomnography after 3 months of CPAP use. They were categorized into groups with good or poor adherence (% days with >= 4 h/night of CPAP use >= 70% or < 70%, respectively). Changes in sleep parameters and plasma fibrinogen levels during the treatment period were compared between these groups. Results The cross-sectional analysis of all reviewed 333 patients indicated that fibrinogen levels were associated with the severities of OSA and PLMS. The 60 patients (27 good and 33 poor adherence) who underwent follow-up polysomnography were included in the longitudinal analysis. The median (interquartile range) periodic limb movement index did not change significantly from CPAP titration to the 3-month follow-up (good adherence: 10.5 (0-23.8) to 10.8 (0-70.2) events/h,p = 0.21; poor adherence: 1.2 (0-14.3) to 0.8 (0-15.7) events/h,p = 0.67). However, the plasma fibrinogen level significantly decreased only in the good adherence group (good adherence: baseline 275 +/- 46 to follow-up 255 +/- 47 mg/dl,p < 0.01; poor adherence: 277 +/- 52 to 284 +/- 70 mg/dl,p = 0.48). Conclusions These results did not support a longitudinal association between PLMS and OSA. However, good adherence to CPAP could reduce plasma fibrinogen levels, thus ameliorating elevations in plasma fibrinogen as a risk factor for future cardiovascular events.