Objective: To investigate the impact of moderate/severe obstructive sleep apnea (OSA) on the prognosis of acute myocardial infarction. Methods: We prospectively selected patients with acute myocardial infarction (AMI) who were hospitalized at the Emergency Critical Care Center of Beijing Anzhen Hospital from June 2015 to May 2017. Patients who met the inclusion criteria were examined with portable sleep respiration monitoring. Patients were divided into moderate/severe OSA group (apnea-hypopnea index (AHI)≥15 beats/hour) and no/mild OSA group (AHI<15 beats/hour) according to sleep AHI. The incidence of major adverse cerebrovascular events (MACCE) after discharge was compared between the two groups, and the independent risk factors of MACCE were analyzed. Results: A total of 432 patients were enrolled in this study, including 211 moderate/severe OSA patients (48.8%). Compared with no/mild OSA group,patients with moderate/severe OSA had higher body mass index ((27.17±3.22) kg/m(2) vs. (25.55±3.44) kg/m(2), t=-5.033,P<0.001), higher proportion of history of percutaneous coronary intervention (PCI) (18.5%(39/211) vs. 8.6%(19/221), χ(2)=9.076,P=0.003), and higher proportion of 3-vessel disease (31.3%(66/211) vs. 24.9%(55/221), χ(2)=10.196,P=0.017). The median follow-up time was 1.0 (0.7, 1.7) years. The incidence of MACCE in the moderate/severe OSA and no/mild group was 19.9%(42/211) and 11.3%(25/221), respectively. Kaplan-Meier analysis showed a higher cumulative risk of MACCE in patients with moderate/severe OSA (log-rank test,χ(2)=5.467, P=0.019). Multivariate Cox regression analysis showed that moderate/severe OSA (HR=1.915, 95%CI 1.016-3.611, P=0.045) and diabetes mellitus (HR=1.819, 95%CI 1.022-3.238, P=0.042) were independent risk factors for MACCE at 1 year post discharge in patients with AMI. Conclusions: Nearly half of AMI patients are complicated with moderate/severe OSA in this patient cohort. Coronary artery disease is more severe in AMI patients complicating with moderate/severe OSA. Moderate/severe OSA is an independent risk factor for MACCE at 1 year after discharge in patients with AMI. Whether the prognosis of AMI can be improved by intervention of OSA remains to be investigated. Trial Registration: Clinical Trial.gov, NCT03362385.
目的： 探讨中/重度阻塞性睡眠呼吸暂停（OSA）对急性心肌梗死（AMI）患者预后的影响。 方法： 前瞻性入选2015年6月至2017年5月于首都医科大学附属北京安贞医院急诊危重症中心住院的AMI患者，对符合入选和排除标准的患者行便携式睡眠呼吸监测检查，根据呼吸暂停低通气指数（AHI）将患者分为中/重度OSA组（AHI≥15次/h）和无/轻度OSA组（AHI<15次/h），比较两组患者出院后主要不良心脑血管事件（MACCE）的发生率，多因素Cox回归分析MACCE的独立危险因素。 结果： 研究共入选患者432例，其中中/重度OSA患者211例（48.8%）。与无/轻度OSA患者相比，中/重度OSA患者体重指数较高[（27.17±3.22）kg/m(2)比（25.55±3.44）kg/m(2)，t=-5.033，P<0.001]，既往接受经皮冠状动脉介入治疗的比例较高[18.5%（39/211）比8.6%（19/221），χ(2)=9.076，P=0.003]，3支病变比例较高[31.3%（66/211）比24.9%（55/221），χ(2)=10.196，P=0.017]。中位随访时间1.0（0.7，1.7）年，中/重度OSA组和无/轻度OSA组患者MACCE发生率分别为19.9%（42/211）和11.3%（25/221）。Kaplan-Meier分析显示，中/重度OSA组患者MACCE累计风险更高（log-rank检验，χ(2)=5.467，P=0.019）。多因素Cox回归分析显示，中/重度OSA（HR=1.915，95%CI 1.016~3.611，P=0.045）和糖尿病（HR=1.819，95%CI 1.022~3.238，P=0.042）是AMI患者1年MACCE的独立危险因素。 结论： AMI患者中近一半合并中/重度OSA，AMI合并中/重度OSA患者病变较为严重，其是AMI患者1年MACCE的独立危险因素。 临床试验注册号： Clinical Trial.gov，NCT03362385。.
Keywords: Myocardial infarction; Prognosis; Sleep apnea, obstructive.