摘要
目的 明确阻塞性睡眠呼吸暂停(OSA)患者不同伴随症状对心脑血管疾病及糖尿病事件发生风险的影响。 方法 回顾性收集2011年1月4日至2016年12月28日唐都医院睡眠中心诊断为OSA的患者,将患者根据伴随症状分为A组:OSA不伴失眠及日间过度思睡(EDS)组、B组:OSA伴失眠组、C组:OSA伴EDS组和D组:OSA伴失眠及EDS组,通过电话随访的方式对患者进行6~11年的随访。结局指标为复合心脑血管及糖尿病事件(包括新发或再发心脏病、脑梗死、脑出血,新发高血压和糖尿病)。使用Kaplan-Meier法绘制生存曲线,采用Log-Rank检验比较OSA患者伴失眠和(或)EDS症状的预后情况,并构建多因素Cox比例风险模型分析OSA患者发生不良结局事件的影响因素。 结果 纳入504例OSA患者,最终307例配合完成随访,男274例,女33例,年龄(49±11)岁,其中A组27例,B组143例,C组27例,D组110例。中位随访7.7年,78例发生心脑血管疾病及糖尿病事件。其中A组发生结局事件1例(3.70%),B组发生30例(20.98%),C组发生10例(37.04%),D组发生37例(33.64%)。与A组患者相比,B组( P =0.034)、C组( P =0.004)、D组( P =0.003)两两组间结局事件的发生率差异有统计学意义。在校正了年龄、性别、体质指数、呼吸暂停低通气指数、基线心脑血管及糖尿病等风险因素和随后的持续气道正压通气治疗情况后,相较于A组,C组( HR =9.67,95% CI :1.23~76.37, P =0.031)和D组患者( HR =11.35,95% CI :1.55~83.43, P =0.017)发生心脑血管及糖尿病的风险增加。 结论 在长期随访成功的OSA患者中,伴失眠和EDS症状是发生心脑血管疾病及糖尿病的危险因素。临床工作中应评估OSA患者的失眠和EDS症状,寻找原因并针对性干预。
Objective To investigate the effects of different accompanying symptoms on the risk of cardiovascular and cerebrovascular and diabetes events in patients with obstructive sleep apnea(OSA).Methods Patients diagnosed with OSA in the sleep center of Tangdu Hospital from January 4,2011 to December 28,2016 were retrospectively collected and divided into four groups according to accompanying symptoms:group A included OSA patients without insomnia and excessive daytime sleepiness(EDS),group B included OSA patients with insomnia,group C included OSA patients with EDS and group D included OSA patients with insomnia and EDS.Patients were followed up by telephone for 6 to 11 years.Outcome measures were composite cardiovascular and cerebrovascular and diabetes events(including new onset or recurrent heart disease,cerebral infarction,cerebral hemorrhage,newly diagnosed hypertension and diabetes).Kaplan-Meier method was used to draw survival curves,log-rank test was performed to compare the prognosis of OSA patients with insomnia and/or EDS symptoms,and multivariate Cox proportional hazards model was constructed to analyze the influencing factors of adverse outcome events in OSA patients.Results Five hundred and four patients with OSA were included,and 307 patients[274 males and 33 females,aged(49±11)years]completed the follow-up,including 27 patients in group A,143 patients in group B,27 patients in group C,and 110 patients in group D.After a median follow-up of 7.7 years,78 patients developed cardiovascular and cerebrovascular and diabetes events.Outcome events occurred in 1 patient(3.70%)in group A,30(20.98%)in group B,10(37.04%)in group C,and 37(33.64%)in group D.Compared with patients in group A,there was a statistically significant difference in the incidence of outcome events in groups B(P=0.034),C(P=0.004),and D(P=0.003).After adjusting for age,sex,body mass index,apnea-hypopnea index,baseline cardiovascular and cerebrovascular risk factors and subsequent continuous positive airway pressure therapy,patients in group C(HR=9.67,95%CI:1.23-76.37,P=0.031)and group D(HR=11.35,95%CI:1.55-83.43,P=0.017)had an increased risk of cardiovascular and cerebrovascular and diabetes events when compared with group A.Conclusions In OSA patients with successful long-term follow-up,insomnia and EDS symptoms are risk factors for the development of cardiovascular and cerebrovascular and diabetes events.Insomnia and EDS symptoms should be evaluated in patients with OSA during clinical practice to find the cause and carry out the targeted intervention.
作者
张丽萍
程金湘
任佳封
刘宇航
薛盛文
赵显超
宿长军
Zhang Liping;Cheng Jinxiang;Ren Jiafeng;Liu Yuhang;Xue Shengwen;Zhao Xianchao;Su Changjun(Department of Neurology,Tangdu Hospital of Air Force Medical University of PLA,Xi′an 710038,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2023年第11期835-841,共7页
National Medical Journal of China
基金
国家重点研发计划重点专项(2021YFC2501401)
