持續氣道正壓通氣或上呼吸道手術治療對合并阻塞性睡眠呼吸暫停冠心病患者預后影響的系統評價_《中國循證醫學雜志》

作者：

 王少麗 , 史大卓 , 王承龍

中國中醫科學院西苑醫院心血管中心（北京 100091）;

關鍵詞：

阻塞性睡眠呼吸暫停冠心病預后系統評價

DOI：

10.7507/1672-2531.20120172

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目的　系統評價持續氣道正壓通氣（CPAP）或上呼吸道手術治療對合并阻塞性睡眠呼吸暫停（OSA）的冠心病患者預后的影響。
方法　計算機檢索Cochrane Library、PubMed、Ovid和CBM，檢索時限均從建庫至2009年10月，收集關于CPAP或上呼吸道手術治療對合并OSA的冠心病患者預后影響的隨機對照試驗、隊列研究，由兩位研究者按照納入與排除標準獨立進行資料提取和質量評價后，采用RevMan 4.3.2軟件進行Meta分析。
結果　初檢出355篇文獻，最終納入4個隊列研究，共945例患者。研究結果顯示：經CPAP治療的合并OSA的冠狀動脈介入治療（PCI）后的冠心病患者，其晚期管腔丟失率、10年病死率與不合并OSA的冠心病患者差異無統計學意義［RR=1.84，95%CI（0.73，4.68），P=0.20；RR=0.80，95%CI（0.24，2.64），P=0.71］；經CPAP或腭咽成形術治療的合并OSA的PCI后冠心病患者，5年心源性病死率較未治療的患者低［RR=0.34，95%CI（0.14，0.82），P=0.02］，但5年全因性病死率、主要不良心血管事件（MACE）發生率差異均無統計學意義［RR=0.66，95%CI（0.39，1.10），P=0.11；R=0.97，95%CI（0.81，1.15），P=0.69］；經CPAP或鼻甲切除術治療的合并OSA的冠心病患者，86.5±39個月后MACE發生率較未治療患者降低［RR=0.22，95%CI（0.07，0.72），P=0.01］。
結論　有限證據顯示，采用CPAP或上呼吸道手術的方法治療合并OSA的冠心病患者，可降低心源性病死率，但對全因性病死率、MACE發生率等遠期預后影響尚需進一步評價。由于納入研究的設計和方法學質量差，樣本量小，上述結論未來研究結果可能不一致，尚需前瞻性、高質量、大樣本量研究證實。

引用本文： 王少麗,史大卓,王承龍. 持續氣道正壓通氣或上呼吸道手術治療對合并阻塞性睡眠呼吸暫停冠心病患者預后影響的系統評價. 中國循證醫學雜志, 2012, 12(9): 1105-1109. doi: 10.7507/1672-2531.20120172 復制

1.	Butt M, Dwivedi G, Khair O, et al. Obstructive sleep apnea and cardiovascular disease. Int J Cardiol, 2009, 139(1): 7-16.
2.	Lee W, Nagubadi S, Kryger MH, et al. Epidemiology of obstructive sleep apnea: a population-based perspective. Expert Rev Respir Med, 2008, 2(3): 349-364.
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4.	Gami AS, Rader S, Svatikova A, et al. Familial premature coronary artery disease mortality and obstructive sleep apnea. Chest, 2007, 131(1): 118-121.
5.	McNicholas WT, Bonsignore MR. the Management Committee of EU Cost Action B26. Sleep apnoea as an independent risk factor for cardiovascular disease. Current evidence, basic mechanisms and research priorities. Eur Respir J, 2007, 29: 156-178.
6.	Shamsuzzaman AS, Gersh BJ, Somers VK. Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA, 2003, 290: 1906-1914.
7.	Michael T. Snoring and carotid artery atherosclerosis. Current Neurology and Neuroscience Reports, 2009, 9(2): 97-98.
8.	Sorajja D, Gami AS, Somers VK, et al. Independent association between obstructive sleep apnea and subclinical coronary artery disease. Chest, 2008, 133(4): 927-933.
9.	Hagenaha GC, Gueven E, Andreas S. Influence of obstructive sleep apnoea in coronary artery disease: a 10-year follow-up. Respir Med, 2006, 100(1): 180-182.
10.	王菡僑. 睡眠呼吸暫停與心腦血管疾病. 中國全科醫學, 2007, 10(2): 99-101.
11.	Cassar A, Morgenthaler TI, Lennon RJ, et al. Treatment of obstructive sleep apnea is associated with decreased cardiac death after percutaneous coronary intervention. J Am Coll Cardiol, 2007, 50(14): 1310-1314.
12.	Milleron O, Pillière R, Foucher A, et al. Benefits of obstructive sleep apnoea treatment in coronary artery disease: a long-term follow-up study. Eur Heart J, 2004, 25(9): 728-734.
13.	Steiner S, Schueller PO, Hennersdorf MG, et al. Impact of obstructive sleep apnea on the occurrence of restenosis after elective percutaneous coronary intervention in ischemic heart disease. Respir Res, 2008, 9(1): 1-7.
14.	McDaid C, Dure´e KH, Griffin SC, et al. A systematic review of continuous positive airway pressure for obstructive sleep apnoea- hypopnoea syndrome. Sleep Med Rev, 2009, 13(6): 427-436.
15.	Martin JM, Carrizo SJ, Vicente E, et al. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet, 2005, 365(9464): 1046-1053.
16.	Pack AI, Gislason T. Obstructive sleep apnea and cardiovascular disease: a perspective and future directions. Prog Cardiovasc Dis, 2009, 51(5): 434-451.

1. Butt M, Dwivedi G, Khair O, et al. Obstructive sleep apnea and cardiovascular disease. Int J Cardiol, 2009, 139(1): 7-16.
2. Lee W, Nagubadi S, Kryger MH, et al. Epidemiology of obstructive sleep apnea: a population-based perspective. Expert Rev Respir Med, 2008, 2(3): 349-364.
3. 胡大一, 馬長生, 方圻, 等. 心臟病學實2009: 新進展與臨床案例. 北京: 人民衛生出版社, 2009: 361.
4. Gami AS, Rader S, Svatikova A, et al. Familial premature coronary artery disease mortality and obstructive sleep apnea. Chest, 2007, 131(1): 118-121.
5. McNicholas WT, Bonsignore MR. the Management Committee of EU Cost Action B26. Sleep apnoea as an independent risk factor for cardiovascular disease. Current evidence, basic mechanisms and research priorities. Eur Respir J, 2007, 29: 156-178.
6. Shamsuzzaman AS, Gersh BJ, Somers VK. Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA, 2003, 290: 1906-1914.
7. Michael T. Snoring and carotid artery atherosclerosis. Current Neurology and Neuroscience Reports, 2009, 9(2): 97-98.
8. Sorajja D, Gami AS, Somers VK, et al. Independent association between obstructive sleep apnea and subclinical coronary artery disease. Chest, 2008, 133(4): 927-933.
9. Hagenaha GC, Gueven E, Andreas S. Influence of obstructive sleep apnoea in coronary artery disease: a 10-year follow-up. Respir Med, 2006, 100(1): 180-182.
10. 王菡僑. 睡眠呼吸暫停與心腦血管疾病. 中國全科醫學, 2007, 10(2): 99-101.
11. Cassar A, Morgenthaler TI, Lennon RJ, et al. Treatment of obstructive sleep apnea is associated with decreased cardiac death after percutaneous coronary intervention. J Am Coll Cardiol, 2007, 50(14): 1310-1314.
12. Milleron O, Pillière R, Foucher A, et al. Benefits of obstructive sleep apnoea treatment in coronary artery disease: a long-term follow-up study. Eur Heart J, 2004, 25(9): 728-734.
13. Steiner S, Schueller PO, Hennersdorf MG, et al. Impact of obstructive sleep apnea on the occurrence of restenosis after elective percutaneous coronary intervention in ischemic heart disease. Respir Res, 2008, 9(1): 1-7.
14. McDaid C, Dure´e KH, Griffin SC, et al. A systematic review of continuous positive airway pressure for obstructive sleep apnoea- hypopnoea syndrome. Sleep Med Rev, 2009, 13(6): 427-436.
15. Martin JM, Carrizo SJ, Vicente E, et al. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet, 2005, 365(9464): 1046-1053.
16. Pack AI, Gislason T. Obstructive sleep apnea and cardiovascular disease: a perspective and future directions. Prog Cardiovasc Dis, 2009, 51(5): 434-451.

《中國循證醫學雜志》

持續氣道正壓通氣或上呼吸道手術治療對合并阻塞性睡眠呼吸暫停冠心病患者預后影響的系統評價

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《中國循證醫學雜志》

持續氣道正壓通氣或上呼吸道手術治療對合并阻塞性睡眠呼吸暫停冠心病患者預后影響的系統評價

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