老年男性阻塞性睡眠呼吸暂停与失眠共病患者发生不良心血管事件的风险  

Risk of adverse cardiovascular events in male elderly with combined morbid insomnia and sleep apnea

作　　者：房凤凤 边红艳[1] 高莹卉 李开亮[3] 韩继明[1] 刘敏 谈燕聪[4] 刘霖[4] Fang Fengfeng;Bian Hongyan;Gao Yinghui;Li Kailiang;Han Jiming;Liu Min;Tan Yancong;Liu Lin(Medical College,Yan'an University,Yan'an 716000,Shaanxi Province,China)

机构地区：[1]延安大学医学院,716000 [2]北京大学国际医院睡眠中心 [3]解放军总医院第二医学中心心血管内科 [4]解放军总医院第二医学中心呼吸与危重症医学科国家老年疾病临床医学研究中心 [5]宁夏盐池县中医医院内科

出　　处：《中华老年心脑血管病杂志》2023年第4期390-393,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：军队保健专项科研课题(19BJZ34);军队装备建设应用研究项目(LB20211A010013)。

摘　　要：目的探讨阻塞性睡眠呼吸暂停与失眠共病(COMISA)患者主要不良心血管事件(MACE)的发生风险。方法纳入2015年1月至2017年10月解放军总医院、北京大学国际医院、北京大学人民医院、甘肃中医药大学附属医院、北京朝阳医院和解放军第九六〇医院睡眠中心门诊或住院的老年男性阻塞性睡眠呼吸暂停(OSA)患者546例,以是否伴有失眠将患者分为非COMISA组(447例)和COMISA组(99例),收集研究对象的人口学特征、临床特征、合并症、睡眠参数与实验室检查结果,随访终点为发生MACE。结果老年男性COMISA的患病率为18.1%。与非COMISA组相比,COMISA组体质量、体质量指数、收缩压、呼吸暂停低通气指数、氧减指数、最低脉搏血氧饱和度、低密度脂蛋白胆固醇、空腹血糖、天冬氨酸转氨酶、血小板计数、白细胞计数、高血压、冠心病、糖尿病、脑血管病、心房颤动差异有统计学意义(P<0.05)。随访期间MACE 61例(11.2%)。COMISA组的累积生存率低于非COMISA组(P_(log rank)<0.01)。Cox分析显示,失眠(HR=2.492,95%CI:1.339~4.639,P=0.004)是老年男性OSA患者MACE发生的危险因素。结论失眠是老年男性OSA患者发生MACE风险的独立危险因素。Objective To investigate the risk of major adverse cardiovascular events(MACE)in elderly male patients with combined morbid insomnia and sleep apnea(COMISA).Methods A total of 546elderly male patients with obstructive sleep apnea(OSA)admitted in the sleep centers of Chinese PLA General Hospital,Peking University International Hospital,Peking University People's Hospital,Affiliated Hospital of Gansu University of Chinese Medicine,Beijing Chaoyang Hospital and No.960Hospital of PLA from January 2015to October 2017were enrolled,and then divided into non-COMISA group(447cases)and COMISA group(99cases)based on whether they were accompanied by insomnia.Demographic characteristics,clinical features,medical history,sleep parameters and laboratory examination results were collected.The follow-up endpoint was MACE.Results The incidence of insomnia in elderly male OSA patients was 18.1%.The COMISA group had significant differences with the non-COMISA group in body weight,body mass index,systolic blood pressure,sleep apnea low ventilation index,oxygen reduction index,minimum pulse oxygen saturation,levels of LDL-C,fasting blood glucose and aspartate aminotransferase,counts of platelets and white blood cells,and proportions of hypertension,coronary heart disease,diabetes mellitus,cerebrovascular diseases and atrial fibrillation(P<0.05).There were 61cases(11.2%)of MACE occurring during the follow-up period.The cumulative survival rate was lower in the COMISA group than the non-COMISA group(P_(log rank)<0.01).Cox analysis showed that insomnia(HR=2.492,95%CI:1.339-4.639,P=0.004)was a risk factor for MACE in elderly male patients with OSA.Conclusion Insomnia is an independent risk factor for MACE in elderly male patients with OSA.

关 键 词：失眠症 呼吸睡眠暂停综合征 心脏病 危险因素 男性 

分 类 号：R766[医药卫生—耳鼻咽喉科] R740[医药卫生—临床医学]