阻塞性睡眠呼吸暂停患者MACE或死亡风险及气道正压通气的影响。

IF 21 1区 医学 Q1 RESPIRATORY SYSTEM
Miguel J Divo,Miguel A Martinez-Garcia,Monica Gonzalez,Francisco Campos-Rodriguez,Patricia Lloberes,Marta Marin-Oto,Marta Forner,David Sanz-Rubio,David Nieto,Bartolome R Celli,Jose M Marin,
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引用次数: 0

摘要

理由:关于气道正压(PAP)治疗在降低阻塞性睡眠呼吸暂停(OSA)患者非致死性主要心血管事件(NF-MACE)风险和死亡率方面的有效性的证据仍然存在争议。目的本研究旨在量化PAP治疗对这些风险的影响,并开发一种预测性风险评估器。方法:我们开展了一项多中心、观察性、前瞻性研究,纳入5358例OSA患者,中位随访时间为14年(IQR 10-15年)。我们推导并验证了NF-MACE(包括心肌梗死、中风、血运重建程序和充血性心力衰竭)和全因死亡率的风险估计值,并结合PAP依从性以及临床和睡眠相关数据。结果该队列的平均年龄(sd)为55±11岁,体重指数(bmi)为32.0±5.4 Kg·m-2,呼吸暂停低通气指数(AHI)为35(±22)次/小时;26%为女性,1467例(37%)为PAP粘附。在随访期间,754名参与者经历了NF-MACE,同时记录了858例死亡。有意义的预测因素包括既往心血管事件、非高密度脂蛋白胆固醇≥200 mg·dL-1、COPD诊断、AHI事件/小时≥30次、年龄≥60岁。PAP依从性具有保护作用(OR 0.46; 95% CI: 0.38 - 0.56),绝对风险降低取决于基线风险(中位数为16%,IQR为12-18)。该风险估计器的AUROC为0.75,Brier评分为0.17,敏感性为64%,特异性为75%。结论spap治疗可降低OSA患者NF-MACE的长期风险和死亡率,而开发的风险评估器可提高开始治疗的临床决策。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
MACE or Death Risk in Obstructive Sleep Apnoea and the Effect of Positive Airway Pressure.
RATIONALE Evidence regarding the efficacy of positive airway pressure (PAP) therapy in reducing the risks of non-fatal major cardiovascular events (NF-MACE) and mortality in patients with obstructive sleep apnoea (OSA) remains controversial. OBJECTIVES This study aims to quantify the impact of PAP therapy on these risks and develop a predictive risk estimator. METHODS We conducted a multicentre, observational, prospective study involving 5358 individuals diagnosed with OSA, with a median follow-up of 14 years (IQR 10-15 years). We derived and validated a risk estimator of NF-MACE (including myocardial infarction, stroke, revascularisation procedures, and congestive heart failure) and all-cause mortality, incorporating PAP adherence alongside clinical and sleep-related data. RESULTS The cohort's mean (sd) for age was 55±11 years, the Body Mass Index 32.0±5.4 Kg·m-2, and an apnoea-hypopnea index (AHI) of 35 (±22) events/hour; 26% were females, and 1467 (37%) were PAP adherent. Over the follow-up period, 754 participants experienced NF-MACE, while 858 deaths were recorded. Significant predictors included prior cardiovascular events, non-HDL cholesterol ≥200 mg·dL-1, COPD diagnosis, AHI >30 events/hr, and age >60 years. PAP adherence was protective (OR 0.46; 95% CI: 0.38 to 0.56), and the absolute risk reduction varied depending on the baseline risk (median of 16%, IQR 12-18). The risk estimator yielded an AUROC of 0.75 and a Brier score of 0.17, with 64% sensitivity and 75% specificity. CONCLUSIONS PAP therapy is associated with long-term risk reduction of NF-MACE and mortality in OSA patients, while the developed risk estimator enhances clinical decision-making regarding therapy initiation.
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来源期刊
European Respiratory Journal
European Respiratory Journal 医学-呼吸系统
CiteScore
27.50
自引率
3.30%
发文量
345
审稿时长
2-4 weeks
期刊介绍: The European Respiratory Journal (ERJ) is the flagship journal of the European Respiratory Society. It has a current impact factor of 24.9. The journal covers various aspects of adult and paediatric respiratory medicine, including cell biology, epidemiology, immunology, oncology, pathophysiology, imaging, occupational medicine, intensive care, sleep medicine, and thoracic surgery. In addition to original research material, the ERJ publishes editorial commentaries, reviews, short research letters, and correspondence to the editor. The articles are published continuously and collected into 12 monthly issues in two volumes per year.
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