Obstructive sleep apnea as a risk factor for stroke and death
Obstructive sleep apnea as a risk factor for stroke and death
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DOI：
10.1056/nejmoa043104
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发表时间：
2005-11-10
影响因子：
158.5
通讯作者：
Mohsenin, V
中科院分区：
文献类型：
--
作者：
Yaggi, HK;Concato, J;Mohsenin, V
背景：以往的研究表明，阻塞性睡眠呼吸暂停综合征可能是卒中的重要危险因素。然而，在调整了包括高血压在内的其他危险因素后，该综合征是否与中风或死于任何原因的风险独立相关还没有确定。方法：在这项观察性队列研究中，连续的患者接受多导睡眠图检查，并对后续事件(中风和死亡)进行验证。阻塞性睡眠呼吸暂停综合征的诊断依据是呼吸暂停低通气指数大于或等于5(每小时5次或更多)；呼吸暂停低通气指数小于5的患者为对照组。结果：在1022名入选患者中，697人(68%)患有阻塞性睡眠呼吸暂停综合征。基线时，该综合征患者的平均呼吸暂停低通气指数为35，而对照组的平均呼吸暂停低通气指数为2。在一项未调整的分析中，阻塞性睡眠呼吸暂停综合征与任何原因导致的中风或死亡有关(危险比，2.24；95%可信区间，1.3-3.86；P=0.004)。在调整了年龄、性别、种族、吸烟状况、饮酒状况、体重指数、有无糖尿病、高脂血症、房颤和高血压后，阻塞性睡眠呼吸暂停综合征与中风或死亡的关系仍然具有统计学意义(危险比，1.97；95%可信区间，1.12至3.48；P=0.01)。在趋势分析中，基线时睡眠呼吸暂停严重程度的增加与发生复合终点的风险增加相关(P=0.005)。结论：阻塞性睡眠呼吸暂停综合征显著增加了中风或因任何原因死亡的风险，并且这种增加与包括高血压在内的其他危险因素无关。
BACKGROUND: Previous studies have suggested that the obstructive sleep apnea syndrome may be an important risk factor for stroke. It has not been determined, however, whether the syndrome is independently related to the risk of stroke or death from any cause after adjustment for other risk factors, including hypertension.METHODS: In this observational cohort study, consecutive patients underwent polysomnography, and subsequent events (strokes and deaths) were verified. The diagnosis of the obstructive sleep apnea syndrome was based on an apnea-hypopnea index of 5 or higher (five or more events per hour); patients with an apnea-hypopnea index of less than 5 served as the comparison group. Proportional-hazards analysis was used to determine the independent effect of the obstructive sleep apnea syndrome on the composite outcome of stroke or death from any cause.RESULTS: Among 1022 enrolled patients, 697 (68 percent) had the obstructive sleep apnea syndrome. At baseline, the mean apnea-hypopnea index in the patients with the syndrome was 35, as compared with a mean apnea-hypopnea index of 2 in the comparison group. In an unadjusted analysis, the obstructive sleep apnea syndrome was associated with stroke or death from any cause (hazard ratio, 2.24; 95 percent confidence interval, 1.30 to 3.86; P=0.004). After adjustment for age, sex, race, smoking status, alcohol-consumption status, body-mass index, and the presence or absence of diabetes mellitus, hyperlipidemia, atrial fibrillation, and hypertension, the obstructive sleep apnea syndrome retained a statistically significant association with stroke or death (hazard ratio, 1.97; 95 percent confidence interval, 1.12 to 3.48; P=0.01). In a trend analysis, increased severity of sleep apnea at baseline was associated with an increased risk of the development of the composite end point (P=0.005).CONCLUSIONS: The obstructive sleep apnea syndrome significantly increases the risk of stroke or death from any cause, and the increase is independent of other risk factors, including hypertension.