阻塞性睡眠呼吸暂停低通气综合征对冠心病患者房颤风险影响的系统评价
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摘要
目的 系统评价阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对冠心病患者房颤发病风险的影响。方法 计算机检索PubMed、EMbase、The Cochrane Library、SinoMed、CNKI、WanFang Data和VIP数据库,搜集OSAHS与冠心病或冠状动脉旁路移植术后房颤风险关系的队列研究,检索时限均从建库至2018年7月2日。由2名研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果 最终纳入11个队列研究,包括709例OSAHS患者和975例非OSAHS患者。Meta分析结果显示:OSAHS明显增加冠心病患者房颤的发病风险[RR=2.01,95%CI(1.72,2.36),P<0.000 01]。亚组分析结果显示:①采用多导睡眠监测(PSG)诊断的冠心病合并OSAHS患者发生房颤的风险增加[RR=2.40,95%CI(1.84,3.12),P<0.000 01],其中冠心病合并中重度OSAHS患者发生房颤的风险更高[RR=3.73,95%CI(2.51,5.53),P<0.000 01];②采用柏林问卷调查(BQ)评估的冠心病合并高风险OSAHS患者发生房颤的风险也比冠心病合并低风险OSAHS患者有所增加[RR=1.56,95%CI(1.27,1.92),P<0.000 1]。结论 现有证据表明,合并OSAHS明显增加冠心病患者房颤的发病风险。受纳入研究质量和数量的限制,上述结论尚需开展大规模高质量的研究予以验证。
Objective To systematically review whether or not obstructive sleep apnea hypopnea syndrome(OSAHS) increases the incidence of atrial fibrillation in coronary artery disease patients. Methods PubMed, EMbase,The Cochrane Library, SinoMed, CNKI, VIP and WanFang Data databases were searched for studies on the relationship between OSAHS and the incidence of atrial fibrillation in coronary artery disease patients from inception to July 2 nd, 2018.Two reviewers independently screened literatures, extracted data, and assessed the risk of bias of included studies. Then,meta-analysis was performed by RevMan 5.3 software. Results In total, 11 cohort studies were included, involving 709 in exposed group and 975 in non-exposed group. The results of meta-analysis indicated that OSAHS was associated with the incidence of atrial fibrillation in coronary artery disease patients(RR=2.01, 95%CI 1.72 to 2.36, P<0.000 01). The subgroup analysis showed that OSAHS of PSG diagnosis increased the risk of the incidence of atrial fibrillation in coronary artery disease patients(RR=2.40, 95%CI 1.84 to 3.12, P<0.000 01); moderate and severe OSAHS of PSG diagnosis had higher risk of the incidence of atrial fibrillation in coronary artery disease patients(RR=3.73, 95%CI 2.51 to 5.53, P<0.000 01); high risk OSAHS of Berlin questionnaire assessment increased the incidence of atrial fibrillation in CAD patients(RR=1.56,95%CI 1.27 to 1.92, P<0.000 1). Conclusion The current evidence indicates that OSAHS is associated with an increased risk of atrial fibrillation in coronary artery disease patients. Due to the limitation of quality and quantity of the included studies, more large-scale and fine quality research are needed to warrant the accuracy of conclusion above.
Objective To systematically review whether or not obstructive sleep apnea hypopnea syndrome(OSAHS) increases the incidence of atrial fibrillation in coronary artery disease patients. Methods PubMed, EMbase,The Cochrane Library, SinoMed, CNKI, VIP and WanFang Data databases were searched for studies on the relationship between OSAHS and the incidence of atrial fibrillation in coronary artery disease patients from inception to July 2 nd, 2018.Two reviewers independently screened literatures, extracted data, and assessed the risk of bias of included studies. Then,meta-analysis was performed by RevMan 5.3 software. Results In total, 11 cohort studies were included, involving 709 in exposed group and 975 in non-exposed group. The results of meta-analysis indicated that OSAHS was associated with the incidence of atrial fibrillation in coronary artery disease patients(RR=2.01, 95%CI 1.72 to 2.36, P<0.000 01). The subgroup analysis showed that OSAHS of PSG diagnosis increased the risk of the incidence of atrial fibrillation in coronary artery disease patients(RR=2.40, 95%CI 1.84 to 3.12, P<0.000 01); moderate and severe OSAHS of PSG diagnosis had higher risk of the incidence of atrial fibrillation in coronary artery disease patients(RR=3.73, 95%CI 2.51 to 5.53, P<0.000 01); high risk OSAHS of Berlin questionnaire assessment increased the incidence of atrial fibrillation in CAD patients(RR=1.56,95%CI 1.27 to 1.92, P<0.000 1). Conclusion The current evidence indicates that OSAHS is associated with an increased risk of atrial fibrillation in coronary artery disease patients. Due to the limitation of quality and quantity of the included studies, more large-scale and fine quality research are needed to warrant the accuracy of conclusion above.
引文
1 Pietzsch JB, Garner A, Cipriano LE, et al. An integrated healtheconomic analysis of diagnostic and therapeutic strategies in the treatment of moderate-to-severe obstructive sleep apnea. Sleep,2011, 34(6):695-709.
2 Bradley TD, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. Lancet, 2009, 373(9657):82-93.
3 Punjabi NM. The epidemiology of adult obstructive sleep apnea.Proc Am Thorac Soc, 2008, 5(2):136-143.
4 Gami AS, Hodge DO, Herges RM, et al. Obstructive sleep apnea,obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol, 2007, 49(5):565-571.
5 Monahan K, Redline S. Role of obstructive sleep apnea in cardiovascular disease. Curr Opin Cardiol, 2011, 26(6):541-547.
6 Wang TJ, Parise H, Levy D, et al. Obesity and the risk of new-onset atrial fibrillation. JAMA, 2004, 292(20):2471-2477.
7 Rahman F, Kwan GF, Benjamin EJ. Global epidemiology of atrial fibrillation. Nat Rev Cardiol, 2014, 11(11):639-654.
8 Fuster V, Ryden LE, Cannom DS, et al. ACC/AHA/ESC 2006guidelines for the management of patients with atrial fibrillation:full text:a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines(writing committee to revise the 2001 guidelines for the management of patients with atrial fibrillation)developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Europace, 2006, 8(9):651-745.
9 Jongnarangsin K, Chugh A, Good E, et al. Body mass index,obstructive sleep apnea, and outcomes of catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol, 2008, 19(7):668-672.
10 Chilukuri K, Dalal D, Marine JE, et al. Predictive value of obstructive sleep apnoea assessed by the Berlin Questionnaire for outcomes after the catheter ablation of atrial fibrillation. Europace,2009, 11(7):896-901.
11 Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in metaanalyses. Eur J Epidemiol, 2010, 25(9):603-605.
12 Amra B, Niknam N, Sadeghi MMM, et al. Obstructive sleep apnea and postoperative complications in patients undergoing coronary artery bypass graft surgery:a need for preventive strategies. Intern J Prev Med, 2014, 5(11):1446-1451.
13 Grilli F, Pasquino S, Gallinella E, et al. Obstructive sleep apnea(OSA)and cardiovascular risk in patients undergoing CABG(coronary artery by-pass grafting). Rivista Italiana di Neurobiologia, 2007, 4(3-4):197-202.
14 李虹,杜以明.冠心病合并OSAHS患者夜间心律失常情况分析.山东医药, 2009, 49(51):52-53.
15 Mooe T, Gullsby S, Rabben T, et al. Sleep-disordered breathing:a novel predictor of atrial fibrillation after coronary artery bypass surgery. Coron Artery Dis, 1996, 7(6):475-478.
16 Mungan U, Ozeke O, Mavioglu L, et al. The role of the preoperative screening of sleep apnoea by Berlin Questionnaire and Epworth Sleepiness Scale for postoperative atrial fibrillation.Heart Lung Circ, 2013, 22(1):38-42.
17 倪良春,仇杰,刘高利,等. OSAHS严重程度与CABG后新发心房颤动关联研究.中国循证心血管医学杂志, 2017, 9(6):693-695.
18 Patel SV, Gill H, Shahi D, et al. High risk for obstructive sleep apnea hypopnea syndrome predicts new onset atrial fibrillation after cardiac surgery:a retrospective analysis. Sleep Breath, 2018,22(4):1117-1124.
19 Uchoa CHG, Danzi-Soares NJ, Nunes FS, et al. Impact of OSA on cardiovascular events after coronary artery bypass surgery. Chest,2015, 147(5):1352-1360.
20 van Oosten EM, Hamilton A, Petsikas D, et al. Effect of preoperative obstructive sleep apnea on the frequency of atrial fibrillation after coronary artery bypass grafting. Am J Cardiol,2014, 113(6):919-923.
21 Wong JK, Maxwell BG, Kushida CA, et al. Obstructive sleep apnea is an independent predictor of postoperative atrial fibrillation in cardiac surgery. J Cardiothorac Vasc Anesth, 2015, 29(5):11401147.
22 Zhao LP, Kofidis T, Lim TW, et al. Sleep apnea is associated with new-onset atrial fibrillation after coronary artery bypass grafting.Crit Care, 2015, 30(6):1418.
23 Netzer NC, Stoohs RA, Netzer CM, et al. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med, 1999, 131(7):485-491.
24 Yumino D, Wang H, Floras JS, et al. Prevalence and physiological predictors of sleep apnea in patients with heart failure and systolic dysfunction. J Card Fail, 2009, 15(4):279-285.
25 Gami AS, Pressman G, Caples SM. Association of atrial fibrillation and obstructive sleep apnea. Acc Curr J Rev, 2004, 110(4):364.
26 van Wagoner DR, Piccini JP, Albert CM, et al. Progress toward the prevention and treatment of atrial fibrillation:a summary of the heart rhythm society research forum on the treatment and prevention of atrial fibrillation, Washington, DC, December 9-10,2013. Heart Rhythm, 2015, 12(1):e5-e29.
27 Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation:a global burden of disease 2010study. Circulation, 2014, 129(8):837-847.
28 Tanigawa T, Yamagishi K, Sakurai S, et al. Arterial oxygen desaturation during sleep and atrial fibrillation. Heart, 2006,92(12):1854-1855.
29 Cadby G, McArdle N, Briffa T, et al. Severity of OSA is an independent predictor of incident atrial fibrillation hospitalization in a large sleep-clinic cohort. Chest, 2015, 148(4):945-952.
30 Unosawa S, Sezai A, Akahoshi T, et al. Arrhythmia and sleepdisordered breathing in patients undergoing cardiac surgery. J Cardiol, 2012, 60(1):61-65.
31 Kaw R, El Zarif S, Wang L, et al. Obesity as an effect modifier in sleep-disordered breathing and postcardiac surgery atrial fibrillation. Chest, 2017, 151(6):1279-1287.
32 Linz D, Linz B, Hohl M, et al. Atrial arrhythmogenesis in obstructive sleep apnea:therapeutic implications. Sleep Med Rev,2016, 26:87-94.
33 Linz D, Schotten U, Neuberger HR, et al. Negative tracheal pressure during obstructive respiratory events promotes atrial fibrillation by vagal activation. Heart Rhythm, 2011, 8(9):1436-1443.
34 Channaveerappa D, Lux JC, Wormwood KL, et al. Atrial electrophysiological and molecular remodelling induced by obstructive sleep apnoea. J Cell Mol Med, 2017, 21(9):2223-2235.
35 Drager LF, Bortolotto LA, Pedrosa RP, et al. Left atrial diameter is independently associated with arterial stiffness in patients with obstructive sleep apnea:potential implications for atrial fibrillation.Int J Cardiol, 2010, 144(2):257-259.
36 Drager LF, Bortolotto LA, Pedrosa RP, et al. Obstructive sleep apnea, hypertension, and their interaction on arterial stiffness and heart remodeling. Chest, 2007, 131(5):1379-1386.
37 Sahadevan J, Srinivasan D. Treatment of obstructive sleep apnea in patients with cardiac arrhythmias. Curr Treat Options Cardiovasc Med, 2012, 14(5):520-528.
38 Linz D, Mahfoud F, Linz B, et al. Effect of obstructive respiratory events on blood pressure and renal perfusion in a pig model for sleep apnea. Am J Hypertens, 2014, 27(10):1293-1300.
39 Schulz R, Schmidt D, Blum A, et al. Decreased plasma levels of nitric oxide derivatives in obstructive sleep apnoea:response to CPAP therapy. Thorax, 2000, 55(12):1046-1051.
40 Schulz R, Mahmoudi S, Hattar K, et al. Enhanced release of superoxide from polymorphonuclear neutrophils in obstructive sleep apnea. Impact of continuous positive airway pressure therapy. Am J Respir Crit Care Med, 2000, 162(2 Pt 1):566-570.
41 Del Ben M, Fabiani M, Loffredo L, et al. Oxidative stress mediated arterial dysfunction in patients with obstructive sleep apnoea and the effect of continuous positive airway pressure treatment. BMC Pulm Med, 2012, 12:36.
42 Schwarz EI, Puhan MA, Schlatzer C, et al. Effect of CPAP therapy on endothelial function in obstructive sleep apnoea:a systematic review and meta-analysis. Respirology, 2015, 20(6):889-895.
2 Bradley TD, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. Lancet, 2009, 373(9657):82-93.
3 Punjabi NM. The epidemiology of adult obstructive sleep apnea.Proc Am Thorac Soc, 2008, 5(2):136-143.
4 Gami AS, Hodge DO, Herges RM, et al. Obstructive sleep apnea,obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol, 2007, 49(5):565-571.
5 Monahan K, Redline S. Role of obstructive sleep apnea in cardiovascular disease. Curr Opin Cardiol, 2011, 26(6):541-547.
6 Wang TJ, Parise H, Levy D, et al. Obesity and the risk of new-onset atrial fibrillation. JAMA, 2004, 292(20):2471-2477.
7 Rahman F, Kwan GF, Benjamin EJ. Global epidemiology of atrial fibrillation. Nat Rev Cardiol, 2014, 11(11):639-654.
8 Fuster V, Ryden LE, Cannom DS, et al. ACC/AHA/ESC 2006guidelines for the management of patients with atrial fibrillation:full text:a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines(writing committee to revise the 2001 guidelines for the management of patients with atrial fibrillation)developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Europace, 2006, 8(9):651-745.
9 Jongnarangsin K, Chugh A, Good E, et al. Body mass index,obstructive sleep apnea, and outcomes of catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol, 2008, 19(7):668-672.
10 Chilukuri K, Dalal D, Marine JE, et al. Predictive value of obstructive sleep apnoea assessed by the Berlin Questionnaire for outcomes after the catheter ablation of atrial fibrillation. Europace,2009, 11(7):896-901.
11 Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in metaanalyses. Eur J Epidemiol, 2010, 25(9):603-605.
12 Amra B, Niknam N, Sadeghi MMM, et al. Obstructive sleep apnea and postoperative complications in patients undergoing coronary artery bypass graft surgery:a need for preventive strategies. Intern J Prev Med, 2014, 5(11):1446-1451.
13 Grilli F, Pasquino S, Gallinella E, et al. Obstructive sleep apnea(OSA)and cardiovascular risk in patients undergoing CABG(coronary artery by-pass grafting). Rivista Italiana di Neurobiologia, 2007, 4(3-4):197-202.
14 李虹,杜以明.冠心病合并OSAHS患者夜间心律失常情况分析.山东医药, 2009, 49(51):52-53.
15 Mooe T, Gullsby S, Rabben T, et al. Sleep-disordered breathing:a novel predictor of atrial fibrillation after coronary artery bypass surgery. Coron Artery Dis, 1996, 7(6):475-478.
16 Mungan U, Ozeke O, Mavioglu L, et al. The role of the preoperative screening of sleep apnoea by Berlin Questionnaire and Epworth Sleepiness Scale for postoperative atrial fibrillation.Heart Lung Circ, 2013, 22(1):38-42.
17 倪良春,仇杰,刘高利,等. OSAHS严重程度与CABG后新发心房颤动关联研究.中国循证心血管医学杂志, 2017, 9(6):693-695.
18 Patel SV, Gill H, Shahi D, et al. High risk for obstructive sleep apnea hypopnea syndrome predicts new onset atrial fibrillation after cardiac surgery:a retrospective analysis. Sleep Breath, 2018,22(4):1117-1124.
19 Uchoa CHG, Danzi-Soares NJ, Nunes FS, et al. Impact of OSA on cardiovascular events after coronary artery bypass surgery. Chest,2015, 147(5):1352-1360.
20 van Oosten EM, Hamilton A, Petsikas D, et al. Effect of preoperative obstructive sleep apnea on the frequency of atrial fibrillation after coronary artery bypass grafting. Am J Cardiol,2014, 113(6):919-923.
21 Wong JK, Maxwell BG, Kushida CA, et al. Obstructive sleep apnea is an independent predictor of postoperative atrial fibrillation in cardiac surgery. J Cardiothorac Vasc Anesth, 2015, 29(5):11401147.
22 Zhao LP, Kofidis T, Lim TW, et al. Sleep apnea is associated with new-onset atrial fibrillation after coronary artery bypass grafting.Crit Care, 2015, 30(6):1418.
23 Netzer NC, Stoohs RA, Netzer CM, et al. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med, 1999, 131(7):485-491.
24 Yumino D, Wang H, Floras JS, et al. Prevalence and physiological predictors of sleep apnea in patients with heart failure and systolic dysfunction. J Card Fail, 2009, 15(4):279-285.
25 Gami AS, Pressman G, Caples SM. Association of atrial fibrillation and obstructive sleep apnea. Acc Curr J Rev, 2004, 110(4):364.
26 van Wagoner DR, Piccini JP, Albert CM, et al. Progress toward the prevention and treatment of atrial fibrillation:a summary of the heart rhythm society research forum on the treatment and prevention of atrial fibrillation, Washington, DC, December 9-10,2013. Heart Rhythm, 2015, 12(1):e5-e29.
27 Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation:a global burden of disease 2010study. Circulation, 2014, 129(8):837-847.
28 Tanigawa T, Yamagishi K, Sakurai S, et al. Arterial oxygen desaturation during sleep and atrial fibrillation. Heart, 2006,92(12):1854-1855.
29 Cadby G, McArdle N, Briffa T, et al. Severity of OSA is an independent predictor of incident atrial fibrillation hospitalization in a large sleep-clinic cohort. Chest, 2015, 148(4):945-952.
30 Unosawa S, Sezai A, Akahoshi T, et al. Arrhythmia and sleepdisordered breathing in patients undergoing cardiac surgery. J Cardiol, 2012, 60(1):61-65.
31 Kaw R, El Zarif S, Wang L, et al. Obesity as an effect modifier in sleep-disordered breathing and postcardiac surgery atrial fibrillation. Chest, 2017, 151(6):1279-1287.
32 Linz D, Linz B, Hohl M, et al. Atrial arrhythmogenesis in obstructive sleep apnea:therapeutic implications. Sleep Med Rev,2016, 26:87-94.
33 Linz D, Schotten U, Neuberger HR, et al. Negative tracheal pressure during obstructive respiratory events promotes atrial fibrillation by vagal activation. Heart Rhythm, 2011, 8(9):1436-1443.
34 Channaveerappa D, Lux JC, Wormwood KL, et al. Atrial electrophysiological and molecular remodelling induced by obstructive sleep apnoea. J Cell Mol Med, 2017, 21(9):2223-2235.
35 Drager LF, Bortolotto LA, Pedrosa RP, et al. Left atrial diameter is independently associated with arterial stiffness in patients with obstructive sleep apnea:potential implications for atrial fibrillation.Int J Cardiol, 2010, 144(2):257-259.
36 Drager LF, Bortolotto LA, Pedrosa RP, et al. Obstructive sleep apnea, hypertension, and their interaction on arterial stiffness and heart remodeling. Chest, 2007, 131(5):1379-1386.
37 Sahadevan J, Srinivasan D. Treatment of obstructive sleep apnea in patients with cardiac arrhythmias. Curr Treat Options Cardiovasc Med, 2012, 14(5):520-528.
38 Linz D, Mahfoud F, Linz B, et al. Effect of obstructive respiratory events on blood pressure and renal perfusion in a pig model for sleep apnea. Am J Hypertens, 2014, 27(10):1293-1300.
39 Schulz R, Schmidt D, Blum A, et al. Decreased plasma levels of nitric oxide derivatives in obstructive sleep apnoea:response to CPAP therapy. Thorax, 2000, 55(12):1046-1051.
40 Schulz R, Mahmoudi S, Hattar K, et al. Enhanced release of superoxide from polymorphonuclear neutrophils in obstructive sleep apnea. Impact of continuous positive airway pressure therapy. Am J Respir Crit Care Med, 2000, 162(2 Pt 1):566-570.
41 Del Ben M, Fabiani M, Loffredo L, et al. Oxidative stress mediated arterial dysfunction in patients with obstructive sleep apnoea and the effect of continuous positive airway pressure treatment. BMC Pulm Med, 2012, 12:36.
42 Schwarz EI, Puhan MA, Schlatzer C, et al. Effect of CPAP therapy on endothelial function in obstructive sleep apnoea:a systematic review and meta-analysis. Respirology, 2015, 20(6):889-895.