阻塞性睡眠呼吸暂停与慢性充血性心力衰竭患者远期预后的相关性研究  

The relationship between obstructive sleep apnea and long-term prognosis in patients with chronic congestive heart failure

作　　者：隋艳梅 徐岩 徐冬梅 SUI Yanmei;XU Yan;XU Dongmei(Department of Children's Rehabilitation,Dongying People's Hospital,Dongying 257100,China)

机构地区：[1]东营区人民医院胜园分院,257100 [2]东营市人民医院儿童康复科 [3]东营区人民医院

出　　处：《心肺血管病杂志》2024年第8期829-835,共7页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)与慢性充血性心力衰竭患者远期预后的相关性。方法:本研究纳入143例慢性充血性心力衰竭患者,根据是否患有OSA分为OSA组(66例)和非OSA组(77例),随访3年。主要终点为主要不良心血管事件(major adverse cardiovascular events,MACE),次要终点为全因死亡、心血管死亡和心力衰竭再住院。采用Kaplan-Meier曲线、Cox比例风险模型、限制性立方样条(restricted cubic spline,RCS)曲线及亚组分析评估OSA与预后的关系。结果:OSA组患者MACE发生率为30.3%,非OSA组为15.6%;OSA组患者心力衰竭再住院发生率为28.8%,非OSA组为14.3%。多元Cox回归分析表明,OSA是MACE(HR=2.64,95%CI:1.11~6.31,P=0.028)和心力衰竭再住院(HR=2.58, 95%CI:1.01~6.61,P=0.048)的独立危险因素。Kaplan-Meier曲线显示OSA组MACE和心力衰竭再住院的发生率均显著高于非OSA组(Log-rank P <0.05)。RCS曲线表明睡眠呼吸暂停低通气指数(apnea-hypopnea index,AHI)与MACE风险呈正相关(非线性P=0.257)。亚组分析未发现显著交互作用(P>0.05)。结论:OSA是慢性充血性心力衰竭患者发生MACE和心力衰竭再住院的独立危险因素,且AHI与MACE风险呈正相关。Objective:To investigate the relationship between obstructive sleep apnea(OSA)and the prognosis of patients with chronic congestive heart failure.Methods:A total of 143 patients with chronic congestive heart failure were enrolled in this study and divided into the OSA group(66 cases)and the non-OSA group(77 cases)based on whether they had OSA.The patients were followed up for 3 years.The primary endpoint was major adverse cardiovascular events(MACE),and the secondary endpoints were allcause mortality,cardiovascular mortality,and heart failure rehospitalization.Kaplan-Meier curves,Cox proportional hazards models,restricted cubic spline(RCS)curves,and subgroup analyses were used to evaluate the relationship between OSA and prognosis.Results:The incidence of MACE was 30.3%in the OSA group and 15.6%in the non-OSA group;meanwhile,the incidence of heart failure rehospitalization was 28.8%in the OSA group and 14.3%in the non-OSA group.Multivariate Cox regression analysis showed that OSA was an independent risk factor for both MACE(HR=2.64,95%CI:1.11-6.31,P=0.028)and heart failure rehospitalization(HR=2.58,95%CI:1.01-6.61,P=0.048).Kaplan-Meier curves showed that the incidence of MACE and heart failure rehospitalization was significantly higher in the OSA group than that in the non-OSA group(Log-rank P<0.05).Additionally,the RCS curve indicated a positive correlation between apnea-hypopnea index(AHI)and MACE risk(nonlinear P=0.257).Subgroup analysis found no significant interaction(P>0.05).Conclusions:OSA is an independent risk factor for MACE and heart failure rehospitalization in patients with chronic congestive heart failure,and AHI is positively correlated with MACE risk.

关 键 词：阻塞性睡眠呼吸暂停 慢性充血性心力衰竭 主要不良心血管事件 睡眠呼吸暂停低通气指数 

分 类 号：R54[医药卫生—心血管疾病]