与睡眠相关的缺氧,右心室功能障碍和1组肺动脉高血压患者的生存率
Megan M Lowery1, Nicholas S Hill2, Lu Wang3
1Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida, USA.
Journal of the American College of Cardiology
|November 15, 2023
概括
与睡眠相关的缺氧,而不是阻塞性睡眠呼吸暂停,在肺动脉高血压 (PAH) 患者中显著恶化右心室功能和存活率. 这突显了氧气脱度对PAH结果的关键影响.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 睡眠医学 睡眠医学
背景情况:
- 第1组肺动脉高血压 (PAH) 是一种致命的疾病,通常导致右心室 (RV) 衰竭,结缔组织疾病 (CTD) 的结果更糟.
- 阻塞性睡眠呼吸暂停 (OSA) 和与睡眠相关的缺氧对PAH中RV功能障碍的作用尚不清楚.
研究的目的:
- 为了前性地研究呼吸暂停-呼吸暂停指数 (AHI) 和与睡眠相关的缺氧与RV功能和患者存活率之间的关联.
- 区分AHI和缺氧对RV功能障碍和PAH死亡率的影响,包括CTD相关的PAH等子组.
主要方法:
- 来自肺血管疾病现象学 (PVDOMICS) 队列的数据分析,包括1组PAH患者和睡眠研究的对照.
- 使用多式RV功能测量,并将其与AHI相关联,记录时间的百分比与氧和率<90% (T90).
- 采用线性模型用于RV测量和Cox比例危险模型用于无移植生存,并根据相关的人口和临床因素进行调整.
主要成果:
- 在186名PAH参与者中,AHI和T90都与减少RV喷射分数有关.
- T90与增加的RV静脉缩压,平均肺动脉压和RV缩有显著的关联.
- T90,但不是AHI,与移植或死亡的5年风险增加17%有关,特别是在非CTD相关的PAH中.
结论:
- 与睡眠相关的缺氧 (T90) 与AHI相比,在PAH中与VR功能障碍和不良生存结果的相关性更强.
- 在CTD相关的PAH中,T90与VR功能障碍有关,但与死亡率或移植无直接关系.
- 这些发现强调了解决与睡眠相关的缺氧在治疗PAH患者中的重要性,以潜在地改善RV功能和生存.
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