Sleep apnea predicts cardiovascular death in patients with Marfan syndrome: a cohort study.

IF 6.5 2区医学 Q1 Medicine

Epma Journal Pub Date : 2022-07-29 eCollection Date: 2022-09-01 DOI:10.1007/s13167-022-00291-4

Nele Gessler, Peter Wohlmuth, Omar Anwar, Eike Sebastian Debus, Christian Eickholt, Melanie A Gunawardene, Samer Hakmi, Kathrin Heitmann, Meike Rybczynski, Helke Schueler, Sara Sheikhzadeh, Eike Tigges, Gunther H Wiest, Stephan Willems, Ekaterina Adam, Yskert von Kodolitsch

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引用次数: 1

Abstract

Background: Surgical replacement of the aortic root is the only intervention that can prevent aortic dissection and cardiovascular death in Marfan syndrome (MFS). However, in some individuals, MFS also causes sleep apnea. If sleep apnea predicts cardiovascular death, a new target for predictive, preventive, and personalized medicine (PPPM) may emerge for those individuals with MFS who have sleep apnea.

Methods: This is an investigator-initiated study with long-term follow-up data of 105 individuals with MFS. All individuals were screened for sleep apnea regardless of symptoms. Cardiovascular death served as a primary endpoint, and aortic events as a secondary outcome.

Results: Sleep apnea with an apnea-hypopnea index (AHI) > 5/h was observed in 21.0% (22/105) with mild sleep apnea in 13% (14/105) and moderate to severe sleep apnea in 7.6% (8/105). After a median follow-up of 7.76 years (interquartile range: 6.84, 8.41), 10% (10/105) had died, with cardiovascular cause of death in 80% (8/10). After adjusting for age and body mass index (BMI), the AHI score emerged as an independent risk factor for cardiovascular death (hazard ratio 1.712, 95% confidence interval [1.061-2.761], p = 0.0276). The secondary outcome of aortic events occurred in 33% (35/105). There was no effect of the AHI score on aortic events after adjusting for age and BMI (hazard ratio 0.965, 95% confidence interval [0.617-1.509]), possibly due to a high number of patients with prior aortic surgery.

Interpretation: Sleep apnea is emerging as an independent predictor of cardiovascular death in MFS. It seems mandatory to screen all individuals with MFS for sleep apnea and to include these individuals, with both MFS and sleep apnea, in further studies to evaluate the impact of preventive measures with regard to cardiovascular death.

Supplementary information: The online version contains supplementary material available at 10.1007/s13167-022-00291-4.

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睡眠呼吸暂停预测马凡氏综合征患者心血管死亡:一项队列研究

背景:手术置换主动脉根部是预防马凡氏综合征(MFS)主动脉夹层和心血管死亡的唯一干预措施。然而，在一些个体中，MFS也会导致睡眠呼吸暂停。如果睡眠呼吸暂停可以预测心血管死亡，那么对于那些患有睡眠呼吸暂停的MFS患者来说，预测、预防和个性化医疗(PPPM)的新目标可能会出现。方法:这是一项由研究者发起的研究，对105名MFS患者进行了长期随访。无论症状如何，所有人都接受了睡眠呼吸暂停筛查。心血管死亡作为主要终点，主动脉事件作为次要终点。结果:21.0%(22/105)存在呼吸暂停-低通气指数(AHI) > 5/h的睡眠呼吸暂停，其中轻度睡眠呼吸暂停占13%(14/105)，中重度睡眠呼吸暂停占7.6%(8/105)。中位随访7.76年(四分位数间距:6.84 ~ 8.41)，10%(10/105)死亡，其中80%(8/10)为心血管原因死亡。在调整年龄和体重指数(BMI)后，AHI评分成为心血管死亡的独立危险因素(风险比1.712,95%可信区间[1.061-2.761]，p = 0.0276)。33%(35/105)发生了主动脉事件的次要结局。在调整年龄和BMI后，AHI评分对主动脉事件没有影响(风险比0.965,95%可信区间[0.617-1.509])，这可能是由于大量患者之前进行过主动脉手术。解释:睡眠呼吸暂停正在成为MFS患者心血管死亡的独立预测因子。似乎有必要对所有MFS患者进行睡眠呼吸暂停筛查，并将这些同时患有MFS和睡眠呼吸暂停的患者纳入进一步的研究，以评估预防措施对心血管死亡的影响。补充信息:在线版本包含补充资料，提供地址为10.1007/s13167-022-00291-4。

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来源期刊

Epma Journal Medicine-Biochemistry (medical)

CiteScore

11.30

自引率

23.10%

发文量

期刊介绍： PMA Journal is a journal of predictive, preventive and personalized medicine (PPPM). The journal provides expert viewpoints and research on medical innovations and advanced healthcare using predictive diagnostics, targeted preventive measures and personalized patient treatments. The journal is indexed by PubMed, Embase and Scopus.