阻塞性睡眠呼吸暂停是静脉血栓栓塞复发的危险因素。

IF 9.5 1区 医学 Q1 CRITICAL CARE MEDICINE
Chest Pub Date : 2016-12-01 Epub Date: 2016-07-21 DOI:10.1016/j.chest.2016.07.011
Alberto Alonso-Fernández, Angela García Suquia, Mónica de la Peña, Raquel Casitas, Javier Pierola, Antonia Barceló, Joan B Soriano, Carmen Fernández-Capitán, Elizabet Martinez-Ceron, Miguel Carrera, Francisco García-Río
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引用次数: 33

摘要

背景:OSA是肺栓塞(PE)首次发作的危险因素,尽管其对血栓栓塞复发风险的影响尚不确定。我们的目的是探讨首次PE患者口服抗凝剂(OAC)停用后OSA的预后价值。方法:在120例连续因首次发作PE而停止OAC的患者中,我们进行了家庭呼吸测谱,并记录了睡眠特征、PE的典型危险因素、血压测量、肺活量测定参数、身体活动、d -二聚体和凝血酶原片段1+2 (F1+2)的水平。随访5 ~ 8年,主要终点为PE复发。对于任何血栓栓塞事件重新启动OAC作为次要终点进行评估。结果:随访期间有19例PE复发,其中16例呼吸暂停低通气指数(AHI)≥10 h-1。在多变量Cox回归模型中,AHI≥10 h-1(风险比[HR], 20.73;95% CI, 1.71-251.28),平均夜间血氧饱和度(nSao2) (HR, 0.39;95%可信区间,0.20 - -0.78),时间Sao2 < 90% (CT90%) (HR 0.90;95% CI, 0.82-0.98)和d -二聚体水平(HR, 1.001;95% CI, 1.00-1.002)是PE复发的独立危险因素。24例患者恢复OAC, AHI≥10 h-1 (HR, 20.66;95% CI, 2.27-188.35),平均nSao2 (HR, 0.54;95% CI, 0.32-0.94)和Epworth嗜睡量表(ESS) (HR, 0.73;95% CI, 0.56-0.97)保留为OAC恢复的独立危险因素。结论:首次PE发作后,OSA是PE复发或新的血栓栓塞事件重新启动OAC的独立危险因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
OSA Is a Risk Factor for Recurrent VTE.

Background: OSA is a risk factor for a first episode of pulmonary embolism (PE), although its impact on the risk of thromboembolism recurring is uncertain. Our objective was to explore the prognostic value of OSA after the discontinuation of oral anticoagulation (OAC) in patients with a first episode of PE.

Methods: In 120 consecutive patients who had stopped OAC for a first episode of PE, we performed home respiratory polygraphy and recorded sleep characteristics, classic risk factors for PE, blood pressure measurements, spirometric parameters, physical activity, and levels of D-dimer and prothrombin fragment 1+2 (F1+2). Patients were followed for 5 to 8 years, and the main end point was PE recurrence. Restarting OAC for any thromboembolic event was evaluated as a secondary end point.

Results: During the follow-up period, 19 patients had a PE recurrence, and 16 of them had an apnea-hypopnea index (AHI) ≥ 10 h-1. In a multivariate Cox regression model, an AHI ≥ 10 h-1 (hazard ratio [HR], 20.73; 95% CI, 1.71-251.28), mean nocturnal oxygen saturation (nSao2) (HR, 0.39; 95% CI, 0.20-0.78), time with Sao2 < 90% (CT90%) (HR, 0.90; 95% CI, 0.82-0.98), and D-dimer level (HR, 1.001; 95% CI, 1.00-1.002) were identified as independent risk factors for recurrent PE. Twenty-four patients resumed OAC, and AHI ≥ 10 h-1 (HR, 20.66; 95% CI, 2.27-188.35), mean nSao2 (HR, 0.54; 95% CI, 0.32-0.94), and Epworth Sleepiness Scale (ESS) (HR, 0.73; 95% CI, 0.56-0.97) were retained as independent risk factors for the resumption of OAC.

Conclusions: After a first episode of PE, OSA is an independent risk factor for PE recurrence or restarting OAC for a new thromboembolic event.

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来源期刊
Chest
Chest 医学-呼吸系统
CiteScore
13.70
自引率
3.10%
发文量
3369
审稿时长
15 days
期刊介绍: At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.
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