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CPAP对阻塞性睡眠呼吸暂停患者心血管事件的预防
CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea


R. Doug McEvoy ... 心脑血管疾病 呼吸系统疾病 • 2016.09.08
相关阅读
• CPAP是否可以预防阻塞性睡眠呼吸暂停患者的不良CV事件

摘要


背景

阻塞性睡眠呼吸暂停与心血管事件危险增加相关,但尚未确定持续气道正压通气(CPAP)治疗是否能够预防严重的心血管事件。

 

方法

在1周的导入期(在此期间参与者采用假性CPAP)后,我们将2,717例符合标准的年龄为45~75岁有中-重度阻塞性睡眠呼吸暂停及冠状动脉或脑血管疾病的成年患者随机分配接受CPAP治疗加常规治疗(CPAP组)或单纯常规治疗(常规治疗组)。主要复合终点为心血管原因死亡、心肌梗死、卒中,或因不稳定型心绞痛、心力衰竭住院,或短暂性脑缺血发作。次要终点包括其他的心血管结局、健康相关生活质量、打鼾症状,以及日间嗜睡度和情绪。

 

结果

大多数参与者为男性,患有中-重度阻塞性睡眠呼吸暂停伴有极轻微瞌睡。在CPAP组,每晚坚持接受CPAP治疗的平均时长为3.3小时,在随访过程中,平均呼吸暂停低通气指数(每小时记录到的呼吸暂停或低通气的事件数)由基线时的29.0次事件/小时降至3.7次事件/小时。平均3.7年的随访后,CPAP组中有229名(17.0%)参与者发生了主要研究终点事件,常规治疗组中有207名(15.4%)参与者发生了主要研究终点事件(CPAP的风险比为1.10;95%可信区间为0.91~1.32;P=0.34)。无论是对主要终点的各项指标,还是对其他复合心血管终点,本研究均未发现CPAP有显著效果。CPAP显著减少了打鼾和日间嗜睡,并改善了健康相关生活质量和情绪。

 

结论

与单纯常规治疗相比,CPAP加常规治疗未能预防已有心血管疾病的中-重度阻塞性睡眠呼吸暂停患者的心血管事件(由澳大利亚国家卫生和医学研究委员会[National Health and Medical Research Council of Australia]等资助,SAVE在ClinicalTrials.gov注册号为NCT00738179;澳大利亚新西兰临床试验注册号[Australian New Zealand Clinical Trials Registry]为ACTRN12608000409370)。





作者信息

R. Doug McEvoy, M.D., Nick A. Antic, M.D., Ph.D., Emma Heeley, Ph.D., Yuanming Luo, M.D., Qiong Ou, M.D., Xilong Zhang, M.D., Olga Mediano, M.D., Rui Chen, M.D., Luciano F. Drager, M.D., Ph.D., Zhihong Liu, M.D., Ph.D., Guofang Chen, M.D., Baoliang Du, M.D., Nigel McArdle, M.D., Sutapa Mukherjee, M.D., Ph.D., Manjari Tripathi, M.D., Laurent Billot, M.Sc., Qiang Li, M.Biostat., Geraldo Lorenzi-Filho, M.D., Ferran Barbe, M.D., Susan Redline, M.D., M.P.H., Jiguang Wang, M.D., Ph.D., Hisatomi Arima, M.D., Ph.D., Bruce Neal, M.D., Ph.D., David P. White, M.D., Ron R. Grunstein, M.D., Ph.D., Nanshan Zhong, M.D., and Craig S. Anderson, M.D., Ph.D., for the SAVE Investigators and Coordinators*
Address reprint requests to Dr. McEvoy at the Adelaide Institute for Sleep Health, Flinders University and Respiratory and Sleep Services, Southern Adelaide Local Health Network, Repatriation General Hospital, Daw Park, Adelaide SA 5041, Australia, or at doug.mcevoy@flinders.edu.au; or to Dr. Luo at the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, Guangzhou, China, or at yuanmingluo9431@yahoo.co.uk. A complete list of sites and trial investigators and coordinators in the Sleep Apnea Cardiovascular Endpoints (SAVE) study is provided in the Supplementary Appendix, available at NEJM.org.

 

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