背景:阻塞性睡眠呼吸暂停(OSA)患者的死亡率预测因子尚待全面了解,尤其是在接受长期随访的大型队列中。我们旨在确定OSA患者死亡率的独立预测因子。
方法:在我们的回顾性队列研究中,纳入3,541例患者,生存数据来自电子病历。人口特征,人体测量,合并症,实验室测试,分析了存活和死亡患者组的多导睡眠图参数。进行了单变量和多变量Cox回归分析,以确定随访至少5年的患者全因死亡率的独立预测因素。
结果:在所有患者中,2,551(72%)患者为男性,平均年龄49.7岁.231例(6.5%)患者死亡。死亡患者明显年龄较大,腰臀比和Epworth嗜睡量表较高(p<0.001,p<0.001,p=0.003)。OSA(非位置和非快速眼动相关),发现睡眠中的周期性肢体运动和睡眠呼吸暂停评分≥1的合并症与死亡率增加相关(p<0.001).死亡组的全身免疫-炎症指数也显著较高(p<0.001)。较高的氧饱和度指数(ODI)和呼吸暂停低通气指数(AHI)与死亡率增加相关(p<0.001)。由于ODI和AHI之间的高度相关性,建立了两个独立的多变量Cox回归模型.虽然AHI在多变量分析中失去了意义,死亡患者组的ODI仍然显著较高(HR=1.007,1.001-1.013,p=0.01)。
结论:ODI,作为唯一的多导睡眠图参数,作为OSA患者死亡率的独立预测因子。
BACKGROUND: Mortality predictors in obstructive sleep apnea (OSA) patients yet to be comprehensively understood, especially within large cohorts undergoing long-term follow-up. We aimed to determine the independent predictors of mortality in OSA patients.
METHODS: In our retrospective cohort study, 3,541 patients were included and survival data was obtained from electronic medical records. Demographic characteristics, anthropometric measurements, comorbidities, laboratory tests, and polysomnography parameters were analyzed for the survived and deceased patient groups. Univariate and multivariate Cox regression analyses were performed to determine independent predictors of all-cause mortality in patients followed for at least 5 years.
RESULTS: Among all patients, 2,551 (72%) patients were male, with a mean age of 49.7 years. 231 (6.5%) patients had died. Deceased patients were significantly older and had higher waist-to-hip ratio and Epworth Sleepiness Scale (p < 0.001, p < 0.001, p = 0.003). OSA (nonpositional and not-rapid eye movement-related), periodic limb movements in sleep and Comorbidities of Sleep Apnea Score ≥ 1 were found to be associated with increased mortality (p < 0.001). Systemic immune-inflammation index was also significantly higher in the deceased group (p < 0.001). Higher oxygen desaturation index (ODI) and apnea-hypopnea index (
AHI) were associated with increased mortality (p < 0.001). Due to the high correlation between ODI and
AHI, two separate multivariate Cox regression models were created. While
AHI lost its significance in the multivariate analysis, ODI remained significantly higher in the deceased patient group (HR = 1.007, 1.001-1.013, p = 0.01).
CONCLUSIONS: ODI, as the only polysomnography parameter, emerged as an independent predictor of mortality in OSA patients.