睡眠呼吸障碍与病死率：一项前瞻性队列研究
Sleep-Disordered Breathing and Mortality: A Prospective Cohort Study
Background:
Sleep-disordered breathing is a common condition associated with adverse health outcomes including hypertension and cardiovascular disease. The overall objective of this study was to determine whether sleep-disordered breathing and its sequelae of intermittent hypoxemia and recurrent arousals are associated with mortality in a community sample of adults aged 40 years or older.
Methods and Findings:
We prospectively examined whether sleep-disordered breathing was associated with an increased risk of death from any cause in 6,441 men and women participating in the Sleep Heart Health Study. Sleep-disordered breathing was assessed with the apnea–hypopnea index (AHI) based on an in-home polysomnogram. Survival analysis and proportional hazards regression models were used to calculate hazard ratios for mortality after adjusting for age, sex, race, smoking status, body mass index, and prevalent medical conditions. The average follow-up period for the cohort was 8.2y during which 1,047 participants (587 men and 460 women) died. Compared to those without sleep-disordered breathing (AHI: <5 events/h), the fully adjusted hazard ratios for all-cause mortality in those with mild (AHI: 5.0–14.9 events/h), moderate (AHI: 15.0–29.9 events/h), and severe (AHI: ≥30.0 events/h) sleep-disordered breathing were 0.93 (95% CI: 0.80–1.08), 1.17 (95% CI: 0.97–1.42), and 1.46 (95% CI: 1.14–1.86), respectively. Stratified analyses by sex and age showed that the increased risk of death associated with severe sleep-disordered breathing was statistically significant in men aged 40–70y (hazard ratio: 2.09; 95% CI: 1.31–3.33). Measures of sleep-related intermittent hypoxemia, but not sleep fragmentation, were independently associated with all-cause mortality. Coronary artery disease–related mortality associated with sleep disordered breathing showed a pattern of association similar to all-cause mortality.
Conclusions:
Sleep-disordered breathing is associated with all-cause mortality and specifically that due to coronary artery disease, particularly in men aged 40–70y with severe sleep-disordered breathing (Fig 1, Table 2).
Sleep-disordered breathing is a common condition associated with adverse health outcomes including hypertension and cardiovascular disease. The overall objective of this study was to determine whether sleep-disordered breathing and its sequelae of intermittent hypoxemia and recurrent arousals are associated with mortality in a community sample of adults aged 40 years or older.
Methods and Findings:
We prospectively examined whether sleep-disordered breathing was associated with an increased risk of death from any cause in 6,441 men and women participating in the Sleep Heart Health Study. Sleep-disordered breathing was assessed with the apnea–hypopnea index (AHI) based on an in-home polysomnogram. Survival analysis and proportional hazards regression models were used to calculate hazard ratios for mortality after adjusting for age, sex, race, smoking status, body mass index, and prevalent medical conditions. The average follow-up period for the cohort was 8.2y during which 1,047 participants (587 men and 460 women) died. Compared to those without sleep-disordered breathing (AHI: <5 events/h), the fully adjusted hazard ratios for all-cause mortality in those with mild (AHI: 5.0–14.9 events/h), moderate (AHI: 15.0–29.9 events/h), and severe (AHI: ≥30.0 events/h) sleep-disordered breathing were 0.93 (95% CI: 0.80–1.08), 1.17 (95% CI: 0.97–1.42), and 1.46 (95% CI: 1.14–1.86), respectively. Stratified analyses by sex and age showed that the increased risk of death associated with severe sleep-disordered breathing was statistically significant in men aged 40–70y (hazard ratio: 2.09; 95% CI: 1.31–3.33). Measures of sleep-related intermittent hypoxemia, but not sleep fragmentation, were independently associated with all-cause mortality. Coronary artery disease–related mortality associated with sleep disordered breathing showed a pattern of association similar to all-cause mortality.
Conclusions:
Sleep-disordered breathing is associated with all-cause mortality and specifically that due to coronary artery disease, particularly in men aged 40–70y with severe sleep-disordered breathing (Fig 1, Table 2).
| Apnea–Hypopnea Index (Events/h) | N | Person–Years | Deaths | Mortality Ratea | Model 1b | Model 2c | Model 3d |
| All participantse | |||||||
| <5.0 | 3,429 | 28,326 | 477 | 16.8 | 1 | 1 | 1 |
| 5.0–14.9 | 1,797 | 14,703 | 319 | 21.7 | 0.90 (0.78–1.04) | 0.93 (0.80–1.07) | 0.93 (0.80–1.08) |
| 15.0–29.9 | 727 | 5,823 | 165 | 28.3 | 1.16 (0.97–1.39) | 1.20 (1.00–1.44) | 1.17 (0.97–1.42) |
| ≥30.0 | 341 | 2,670 | 86 | 32.2 | 1.30 (1.03–1.64) | 1.38 (1.08–1.75) | 1.46 (1.14–1.86) |
| Men | |||||||
| <5.0 | 1,262 | 10,275 | 216 | 21 | 1 | 1 | 1 |
| 5.0–14.9 | 976 | 7,873 | 193 | 24.5 | 0.94 (0.78–1.15) | 0.99 (0.81–1.20) | 1.01 (0.83–1.24) |
| 15.0–29.9 | 462 | 3,651 | 114 | 31.2 | 1.23 (0.98–1.54) | 1.30 (1.03–1.64) | 1.27 (1.00–1.65) |
| ≥30.0 | 242 | 1,872 | 64 | 34.2 | 1.30 (0.98–1.72) | 1.42 (1.06–1.90) | 1.54 (1.15–2.08) |
| Women | |||||||
| <5.0 | 2,167 | 18,050 | 261 | 14.5 | 1 | 1 | 1 |
| 5.0–14.9 | 821 | 6,830 | 126 | 18.5 | 0.84 (0.68–1.04) | 0.85 (0.68–1.06) | 0.83 (0.66–1.04) |
| 15.0–29.9 | 265 | 2,171 | 51 | 23.5 | 1.05 (0.77–1.42) | 1.06 (0.78–1.43) | 1.01 (0.73–1.38) |
| ≥30.0 | 99 | 798 | 22 | 27.6 | 1.34 (0.86–2.07) | 1.37 (0.88–2.13) | 1.40 (0.89–2.22) |
Table 2: Adjusted Hazard Ratios (95% confidence intervals) for All-Cause Mortality Associated with Sleep-Disordered Breathing in the Sleep Heart Health Study
Figure 1: Kaplan-Meier survival curves across categories of the apnea–hypopnea index (AHI). (Courtesy of Punjabi NM, Caffo BS, Goodwin JL, et al. Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med. 2009;6:e1000132.)
学科代码：心血管病学 关键词：睡眠呼吸障碍与病死率：一项前瞻性队列研究
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