Association of Hypoxic Burden With Cardiovascular Events: A Risk Stratification Analysis of the Randomized Intervention With CPAP in Coronary Artery Disease and Sleep Apnea Cohort.

research_question

Is high hypoxic burden (HB) more strongly associated with major cardiovascular and cerebrovascular adverse events (MACCEs) than AHI of ≥ 30 events/h?

高缺氧负荷（HB）是否比AHI≥30次/小时更强烈地与主要心血管和脑血管不良事件（MACCEs）相关？

study_design_and_methods

This secondary analysis of the Randomized Intervention With CPAP in Coronary Artery Disease and Sleep Apnea observational cohort included 368 adults with OSA (AHI ≥ 15 events/h) with (n = 155) and without (n = 244) excessive daytime sleepiness (EDS), defined as an Epworth Sleepiness Scale score of ≥ 10.

这项对冠状动脉疾病和睡眠呼吸暂停症患者进行CPAP干预的随机观察队列的二次分析，包括了368名成人睡眠呼吸暂停症患者（AHI ≥ 15次/小时），其中伴有（n = 155）和不伴有（n = 244）白天过度嗜睡（EDS），EDS定义为Epworth嗜睡量表评分≥10分。

HB was calculated as the total area under respiratory event-related desaturations divided by total sleep time.

HB的计算方法是将呼吸事件相关的去饱和总面积除以总睡眠时间。

Patients were classified as having high or low HB based on the median (60.7%min/h).

患者根据中位数（60.7%min/h）被分类为高或低HB。

The primary outcome was the incident of the first MACCE.

主要结果是首次发生的主要不良脑血管事件（MACCE）的事件。

Cox proportional hazard models assessed associations in the full cohort and by CPAP allocation and adherence (nonadherent or no positive airway pressure [PAP] group, n = 262; adherent [adjusted PAP use ≥ 4 h/night for all nights at 1-year follow-up], n = 106).

Cox比例风险模型评估了全队列以及根据持续气道正压通气（CPAP）分配和依从性（不依从或未使用正压通气[PAP]组，n = 262；依从者[调整后的PAP使用≥4小时/晚，持续1年随访]，n = 106）的关联。

In an exploratory analysis, participants were grouped into 4 categories based on median AHI and HB (low and low, low and high, high and low, and high and high, respectively).

在一项探索性分析中，参与者根据中位数的呼吸暂停低通气指数（AHI）和血红蛋白（HB）被分为4个类别（分别为低和低、低和高、高和低、以及高和高）。

Results

Over a median follow-up of 4.7 years, high HB was associated with MACCEs (adjusted hazard ratio, 1.87; 95% CI, 1.17-2.98; P = .009), particularly among untreated or nonadherent patients and those with baseline EDS.

在中位随访4.7年期间，高HB与MACCEs相关（调整后风险比，1.87；95%置信区间，1.17-2.98；P = .009），特别是在未治疗或不依从的患者以及基线EDS患者中。

AHI of ≥ 30 events/h was not associated significantly with MACCEs (P = .366).

AHI ≥ 30事件/小时与MACCEs无显著相关性（P = .366）。

When modelled continuously, HB and AHI each were associated with MACCEs; however, compared with low AHI and low HB, only high HB, regardless of AHI level, was linked to increased risk.

当连续建模时，血红蛋白（HB）和呼吸暂停低通气指数（AHI）都与主要不良脑心血管事件（MACCEs）相关；然而，与低AHI和低HB相比，只有高HB，无论AHI水平如何，都与增加的风险相关。

In contrast, high AHI and low HB was not associated with MACCEs.

相比之下，高AHI和低HB与主要不良脑心血管事件（MACCEs）无关。

interpretation

High HB, but not AHI of ≥ 30 events/h, was associated with MACCEs in adults with moderate to severe OSA.

在中重度OSA成人患者中，高HB而非AHI≥30次/小时与MACCEs相关。

Although AHI was associated with outcomes when modelled continuously, elevated risk seemed to be driven primarily by high HB.

尽管当AHI以连续变量建模时与结果相关，但增加的风险似乎主要是由高HB驱动的。

clinical_trial_registration

ClinicalTrials.gov; No.: NCT00519597; URL: www.

临床试验注册中心; 编号: NCT00519597; 网址: www.

clinicaltrials

gov.

政府