目的:睡眠呼吸暂停(SA)患者的心血管风险增加。然而,对SA患者院外心脏骤停(OHCA)的风险知之甚少.因此,我们研究了在普通人群中接受和未接受OHCA持续气道正压通气(CPAP)治疗的SA患者之间的关系.
方法:使用全国数据库,我们进行了一项巢式病例-对照研究,研究对象是OHCA-假定的心脏原因和年龄/性别/OHCA日期匹配的非OHCA对照人群.对已知的OHCA危险因素进行调整的条件逻辑回归模型,以生成OHCA的比值比(OR),比较接受SA和未接受CPAP治疗的患者与未接受SA的个体。
结果:我们确定了46,578例OHCA病例和232,890例匹配的非OHCA对照[平均:71年,68.8%男性]。与没有SA的受试者相比,未经CPAP治疗的SA与控制相关混杂因素后OHCA的几率增加相关(OR:1.20,95%-Cl:1.06-1.36),而采用CPAP治疗的SA与OHCA无关(OR:1.04,95%-Cl:0.93-1.36).无论CPAP治疗,年龄和性别对我们的研究结果没有显著影响.我们的发现在以下方面得到了证实:(I)既没有缺血性心脏病也没有心力衰竭的患者(未经治疗的SA,OR:1.24,95%-CI:1.04-1.47;使用CPAP的SA,OR:1.08,95%-CI:0.93-1.25);(II)无心血管疾病的患者(未经治疗的SA,OR:1.33,95%-CI:1.07-1.65;SA与CPAP,OR:1.14,95%-CI:0.94-1.39)。
结论:未使用CPAP治疗的SA与OHCA有关,而接受CPAP治疗的SA患者未发现OHCA风险增加。
OBJECTIVE: Patients with sleep apnea (SA) are at increased cardiovascular risk. However, little is known about the risk of out-of-hospital cardiac arrest (OHCA) in patients with SA. Therefore, we studied the relation between SA patients who did and did not receive continuous positive airway pressure (CPAP) therapy with OHCA in the general population.
METHODS: Using nationwide databases, we conducted a nested case-control
study with OHCA-cases of presumed cardiac causes and age/sex/OHCA-date matched non-OHCA-controls from the general population. Conditional logistic regression models with adjustments for well-known OHCA risk factors were performed to generate odds ratio (OR) of OHCA comparing patients with SA receiving and not receiving CPAP therapy with individuals without SA.
RESULTS: We identified 46,578 OHCA-cases and 232,890 matched non-OHCA-controls [mean: 71 years, 68.8% men]. Compared to subjects without SA, having SA without
CPAP therapy was associated with increased odds of OHCA after controlling for relevant confounders (OR:1.20, 95%-Cl:1.06-1.36), while having SA with CPAP therapy was not associated with OHCA (OR:1.04, 95%-Cl:0.93-1.36). Regardless of
CPAP therapy, age and sex did not significantly influence our findings. Our findings were confirmed in: (I) patients with neither ischemic heart disease nor heart failure (untreated SA, OR:1.24, 95%-CI:1.04-1.47; SA with CPAP, OR:1.08, 95%-CI:0.93-1.25); and (II) in patients without cardiovascular disease (untreated SA, OR:1.33, 95%-CI:1.07-1.65; SA with CPAP, OR:1.14, 95%-CI:0.94-1.39).
CONCLUSIONS: SA not treated with
CPAP was associated with OHCA, while no increased risk of OHCA was found for SA patients treated with
CPAP.