慢性阻塞性肺病患者的倾向匹配队列中的睡眠测试和死亡率
Lucas M Donovan1,2, Travis Wai1, Laura J Spece1,2
1Seattle-Denver Center of Innovation for Veteran-centered and Value-driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
患有COPD和可能未被诊断的阻塞性睡眠呼吸暂停的患者的睡眠测试与较低的死亡率相关,但增加了非致命的不良事件. 基于倾向的分析无法明确区分因果关系与残留混.
科学领域:
- 肺部医学 肺部医学
- 睡眠医学 睡眠医学
- 流行病学 流行病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 阻塞性睡眠呼吸暂停 (OSA) 在慢性阻塞性肺病 (COPD) 患者中很常见.
- 在COPD患者中未被诊断的OSA可能会影响健康结果,但证据有限.
- 倾向匹配方法越来越多地用于分析OSA管理的现实数据.
研究的目的:
- 评估睡眠测试与COPD患者的死亡率之间的关联,COPD患者具有高概率的未诊断的OSA.
- 调查睡眠测试对非致命不良结果和常规COPD护理服务的影响.
主要方法:
- 对135,958名患有慢性肺炎和高概率未诊断的OSA的患者进行了回顾性队列研究.
- 倾向性得分匹配用于比较接受睡眠测试和未接受睡眠测试的患者之间的死亡率和非致命事件.
- 敏感性分析包括逆倾向权重和仪器变量方法;对于非致命事件,考虑了竞争的风险.
主要成果:
- 1.4%的患者 (1957人) 接受了睡眠测试.
- 睡眠测试与死亡风险降低有关 (IRR 0.88;95% CI 0.79-0.99).
- 睡眠测试与非致命不良事件的风险增加有关,包括COPD恶化 (sHR 1.29;95% CI 1.02-1.62) 和流感疫苗接种 (sHR 1.26;95% CI 1.17-1.36).
结论:
- 在这个人群中,睡眠测试可能会降低死亡率,但会增加非致命的不良结果和服务利用率.
- 由于医疗保健获得的差异而导致的残留混不能被排除为研究结果的解释.
- 基于倾向性的分析的局限性凸显了使用这种方法指导临床决策和政策的挑战.
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