根据高风险阻塞性睡眠呼吸暂停,持续正气道压力对心血管的益处:多试验分析
Ali Azarbarzin1, Daniel Vena1, Neda Esmaeili1
1Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Ave, Boston, MA 02115, USA.
European heart journal
|August 12, 2025
概括
持续的正气压 (CPAP) 有利于高风险阻塞性睡眠呼吸暂停 (OSA) 的心血管结果. 然而,CPAP可能会伤害低风险的OSA患者,这表明个性化治疗方法至关重要.
科学领域:
- 心脏病学 心脏病学
- 睡眠医学 睡眠医学
- 呼吸系统医学 呼吸系统医学
背景情况:
- 之前的试验表明,阻塞性睡眠呼吸暂停 (OSA) 的持续正气道压力 (CPAP) 并不能减少心血管疾病患者的主要不良心血管和脑血管事件 (MACCE).
- 这项研究调查了CPAP对心血管的益处是否特定于高风险的OSA,即OSA事件期间的心率加速或低氧化症.
研究的目的:
- 为了确定CPAP治疗是否为患有高风险阻塞性睡眠呼吸暂停 (OSA) 的患者提供心血管益处.
- 分析CPAP对高风险与低风险OSA患者MACCE的差异效应.
主要方法:
- 来自三项主要随机试验 (冠状动脉疾病和OSA中的CPAP,急性冠状动脉综合征和不睡觉OSA患者的CPAP以及睡眠呼吸暂停心血管终点研究) 的数据的后期分析.
- 高风险的OSA被定义为心率响应>9.4 b.p.m. 或低氧负荷>87.1%分/小时.
- 考克斯混合模型用于评估CPAP对MACCE的影响,分层按高风险OSA状态分层,并与通常护理相比较.
主要成果:
- 在高风险的OSA患者中,CPAP治疗对MACCE的影响显著更大 (相互作用危险比率[iHR]0.69,P=0.024).
- 在高风险的OSA患者中,没有过度嗜睡 (iHR 0.59) 或高血压 (iHR 0.54) 的好处更为明显.
- CPAP在高风险的OSA患者中显示出心血管方面的益处,但在低风险的OSA患者中似乎会造成伤害.
结论:
- 持续的正气道压力 (CPAP) 治疗优先改善高风险阻塞性睡眠呼吸暂停 (OSA) 患者的心血管结果.
- 在低风险的OSA患者中观察到的潜在危害可能会抵消益处,强调需要风险分层.
- 这些发现提供了一种方法来确定最有可能从CPAP治疗中获益的OSA患者,以减少心血管风险.
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