文献类型：期刊文献

中文题名：老年男性阻塞性睡眠呼吸暂停患者不良心脑血管事件的发生风险

英文题名：Risk of adverse cardio-cerebrovascular events in elderly male patients with obstructive sleep apnea

作者：苏小凤[1];韩继明[1];刘霖[2,3];高莹卉[4];李建华[5];徐伟豪[6];赵力博[3,5];王欢欢[1];陈开兵[7];林俊岭[8];仲琳[1];郭静静[9];王亚斌[3];钱小顺[2]

第一作者：苏小凤

机构：[1]延安大学医学院,陕西延安716000;[2]中国人民解放军总医院第二医学中心:呼吸与危重症医学科,北京100853;[3]解放军总医院国家老年疾病临床医学研究中心,北京100853;[4]北京大学国际医院睡眠中心,北京102206;[5]中国人民解放军总医院第二医学中心:心血管内科,北京100853;[6]海南省军区海口离职干部休养所,海口570100;[7]甘肃中医药大学附属医院,兰州730000;[8]首都医科大学附属北京朝阳医院呼吸与危重症医学科,北京100020;[9]北京大学人民医院呼吸内科,北京100013

第一机构：延安大学医学院,陕西延安716000

年份：2022

卷号：21

期号：3

起止页码：184

中文期刊名：中华老年多器官疾病杂志

外文期刊名：Chinese Journal of Multiple Organ Diseases in the Elderly

收录：CSTPCD

基金：国家老年疾病临床研究中心2018开放课题(NCRCG-PLAGH-2018008);解放军总医院军事医学青年项目(QNC19054);军队保健专项科研基金(19BJZ34,16BJZ25);解放军总医院第二医学中心专项科研课题(ZXD2008)。

语种：中文

中文关键词：老年人;睡眠呼吸暂停,阻塞性;男性;主要不良心脑血管事件;脑卒中

外文关键词：aged;sleep apnea obstructive;male;major adverse cardiovascular events;stroke

摘要：目的探讨老年男性阻塞性睡眠呼吸暂停(OSA)患者主要不良心血管事件(MACE)和脑卒中的发生风险。方法选择2015年1月至2017年10月解放军总医院、北京大学国际医院等多中心连续纳入的675例符合条件的老年男性OSA患者为研究对象。根据睡眠呼吸暂停低通气指数(AHI)将患者分为轻度OSA组(对照组)、中度OSA组和重度OSA组。对患者进行定期随访(每3个月),随访终点事件为MACE和脑卒中。采用SPSS 26.0统计软件进行数据分析。应用Kaplan-Meier生存分析描述终点事件的累积发生率,Log-rank检验比较组间累积发生率的差异,多因素Cox回归分析老年男性OSA患者MACE和脑卒中的发生风险。结果3组患者年龄、体质量指数(BMI)、氧减指数(ODI)、平均氧饱和度(MSaO2)、最低氧饱和度、SaO2<90%时间占总监测时间比例(TS90%)及颈动脉粥样硬化发生情况比较,差异均有统计学意义(P<0.05)。3组患者脑卒中累计发生率比较,重度OSA组最高,差异有统计学意义(P<0.05);而组间MACE累积发生率比较,差异无统计学意义(P>0.05)。Cox比例风险回归分析结果显示,在43(41~55)个月的中位随访时间中,与对照组相比,重度OSA组患者的脑卒中发生风险增加(HR=5.43,95%CI 1.56~18.82,P<0.05);年龄(HR=1.04,95%CI 1.01~1.08)和颈动脉粥样硬化史(HR=2.64,95%CI 1.51~4.63)是老年男性OSA患者发生MACE风险的独立危险因素(P<0.05),但OSA的严重程度与MACE发生风险的增加无关。结论重度老年男性OSA患者的脑卒中发生风险增加,但OSA严重程度与MACE风险的增加无关。
Objective To analyze the risks for major adverse cardiovascular events(MACE)and stroke in elderly male patients with obstructive sleep apnea(OSA).Methods A multicenter clinical trail was carried out in several hospitals including Chinese PLA General Hospital and Peking University International Hospital during January 2015 to October 2017.A total of 675 consecutive elderly male OSA patients were eligible for inclusion and divided into mild OSA group(control group),moderate OSA group and severe OSA group according to sleep apnea hypopnea index(AHI).All of them were followed up regularly(every 3 months).The end events of follow-up were MACE and stroke.SPSS statistics 26.0 was used for data analysis.Kaplan-Meier survival analysis was employed to describe the cumulative incidence of terminal events,Log-rank test was adopted to compare the cumulative incidence between groups,and multivariate Cox regression analysis was performed to analyze the risks of MACE and stroke in the patients.Results There were statistically significant differences in age,body mass index(BMI),oxygen desaturation index(ODI),mean oxygen saturation(MSaO),minimum oxygen saturation,percentage of the times for SaO<90%in total monitoring time during overnight sleep(TS90%)and occurrence of carotid atherosclerosis among three groups(P<0.05).The cumulative incidence of stroke was the highest in severe OSA group,and the difference was statistically significant(P<0.05).There was no significant difference in cumulative incidence of MACE among three groups(P>0.05).Cox proportional hazard regression analysis showed that during the median follow-up period of 43(41-55)months,only the patients with severe OSA were associated with an increased risk of stroke when compared with the control group(HR=5.43,95%CI 1.56-18.82,P<0.05);age(HR=1.04,95%CI 1.01-1.08,P<0.05)and history of carotid atherosclerosis(HR=2.64,95%CI 1.51-4.63,P<0.05)were independent risk factors for MACE in elderly male patients with OSA,but the severity of OSA was not related to the increased risk of MACE.Conclusion The elderly male patients with severe OSA are of high risk for stroke,but the severity is not related to the risk of MACE.