PDF(Pubmed)
Abstract：
UNASSIGNED: Obstructive sleep apnea (OSA) is common in patients with chronic thromboembolic pulmonary hypertension (CTEPH), but the pathological determinants of adverse outcomes remain unknown. This study aimed to investigate the prognostic significance of various sleep parameters in patients with CTEPH undergoing pulmonary endarterectomy.
UNASSIGNED: Consecutive patients diagnosed with CTEPH who underwent overnight cardiorespiratory polygraphy for the assessment of OSA were enrolled. Time-to-event analysis was performed investigating cardiorespiratory indices (e.g., apnea-hypopnea index [AHI], time percentage with oxygen saturation below < 90% [T90]) and clinical worsening using the log-rank test, and multivariable Cox proportional hazard models adjusted for multiple confounders.
UNASSIGNED: Of the 71 patients with operable CTEPH who underwent overnight cardiorespiratory polygraphy, 36 (50.7%) had OSA (AHI of ≥ 5) and 32 (45.1%) had nocturnal hypoxemia (T90 of ≥ 30%). A 10% increase in T90 was associated with a 27% greater risk of worse hemodynamics, as quantified by mean pulmonary artery pressure of ≥ 46 mmHg (odds ratio: 1.27, 95% confidence interval [CI]: 1.07-1.50, p = 0.006). Clinical worsening (CW) was experienced by 19 (26.8%) patients over a median follow-up of 26.8 months. AHI did not predict a higher risk of CW (hazard ratio [HR]: 1.00, 95% CI: 0.93-1.06, p = 0.906). A higher cumulative incidence of CW was seen in patients with nocturnal hypoxemia than in those with normoxemia (43.8% vs. 12.8%, log-rank p = 0.017). Cox regression analysis revealed the association between nocturnal hypoxemia and an increased risk of CW (HR: 3.27, 95% CI: 1.17-9.13, p = 0.024), and these associations persisted after covariate adjustment.
UNASSIGNED: Nocturnal hypoxemia quantified by T90 was a risk predictor of short- and long-term CW events among patients with operable CTEPH.
UNASSIGNED: Consecutive patients diagnosed with CTEPH who underwent overnight cardiorespiratory polygraphy for the assessment of OSA were enrolled. Time-to-event analysis was performed investigating cardiorespiratory indices (e.g., apnea-hypopnea index [AHI], time percentage with oxygen saturation below < 90% [T90]) and clinical worsening using the log-rank test, and multivariable Cox proportional hazard models adjusted for multiple confounders.
UNASSIGNED: Of the 71 patients with operable CTEPH who underwent overnight cardiorespiratory polygraphy, 36 (50.7%) had OSA (AHI of ≥ 5) and 32 (45.1%) had nocturnal hypoxemia (T90 of ≥ 30%). A 10% increase in T90 was associated with a 27% greater risk of worse hemodynamics, as quantified by mean pulmonary artery pressure of ≥ 46 mmHg (odds ratio: 1.27, 95% confidence interval [CI]: 1.07-1.50, p = 0.006). Clinical worsening (CW) was experienced by 19 (26.8%) patients over a median follow-up of 26.8 months. AHI did not predict a higher risk of CW (hazard ratio [HR]: 1.00, 95% CI: 0.93-1.06, p = 0.906). A higher cumulative incidence of CW was seen in patients with nocturnal hypoxemia than in those with normoxemia (43.8% vs. 12.8%, log-rank p = 0.017). Cox regression analysis revealed the association between nocturnal hypoxemia and an increased risk of CW (HR: 3.27, 95% CI: 1.17-9.13, p = 0.024), and these associations persisted after covariate adjustment.
UNASSIGNED: Nocturnal hypoxemia quantified by T90 was a risk predictor of short- and long-term CW events among patients with operable CTEPH.
摘要：
■阻塞性睡眠呼吸暂停（OSA）在慢性血栓栓塞性肺动脉高压（CTEPH）患者中很常见，但不良结局的病理决定因素仍然未知.本研究旨在探讨各种睡眠参数对接受肺内膜切除术的CTEPH患者的预后意义。
■连续入选诊断为CTEPH的患者，这些患者接受了夜间心肺造影以评估OSA。进行了时间至事件分析，调查了心肺指数(例如，呼吸暂停低通气指数[AHI]，氧饱和度低于90%[T90]的时间百分比)和使用对数秩检验的临床恶化，和多变量Cox比例风险模型调整了多个混杂因素。
■在71例接受了可手术的CTEPH的患者中，36例（50.7％）患有OSA（AHI≥5），32例（45.1％）患有夜间低氧血症（T90≥30％）。T90增加10%与血流动力学恶化的风险增加27%相关,通过平均肺动脉压≥46mmHg(比值比:1.27,95%置信区间[CI]:1.07-1.50,p=0.006)量化.在平均26.8个月的随访中，有19例（26.8％）患者经历了临床恶化（CW）。AHI未预测CW的风险较高（风险比[HR]：1.00，95％CI：0.93-1.06，p=0.906）。夜间低氧血症患者的CW累积发生率高于正常氧血症患者（43.8％vs.12.8%,对数秩p=0.017)。Cox回归分析显示夜间低氧血症与CW风险增加之间存在关联(HR:3.27,95%CI:1.17-9.13,p=0.024),这些关联在协变量调整后仍然存在。
■通过T90量化的夜间低氧血症是可手术CTEPH患者短期和长期CW事件的风险预测因子。
■连续入选诊断为CTEPH的患者，这些患者接受了夜间心肺造影以评估OSA。进行了时间至事件分析，调查了心肺指数(例如，呼吸暂停低通气指数[AHI]，氧饱和度低于90%[T90]的时间百分比)和使用对数秩检验的临床恶化，和多变量Cox比例风险模型调整了多个混杂因素。
■在71例接受了可手术的CTEPH的患者中，36例（50.7％）患有OSA（AHI≥5），32例（45.1％）患有夜间低氧血症（T90≥30％）。T90增加10%与血流动力学恶化的风险增加27%相关,通过平均肺动脉压≥46mmHg(比值比:1.27,95%置信区间[CI]:1.07-1.50,p=0.006)量化.在平均26.8个月的随访中，有19例（26.8％）患者经历了临床恶化（CW）。AHI未预测CW的风险较高（风险比[HR]：1.00，95％CI：0.93-1.06，p=0.906）。夜间低氧血症患者的CW累积发生率高于正常氧血症患者（43.8％vs.12.8%,对数秩p=0.017)。Cox回归分析显示夜间低氧血症与CW风险增加之间存在关联(HR:3.27,95%CI:1.17-9.13,p=0.024),这些关联在协变量调整后仍然存在。
■通过T90量化的夜间低氧血症是可手术CTEPH患者短期和长期CW事件的风险预测因子。
