Eur Respir J: 阻塞性睡眠呼吸暂停在外周血管疾病患者中发病率很高

外周动脉疾病（PAD）是动脉粥样硬化综合征的一种，提示严重的全身性血管疾病。PAD手术病人预后不良，血管重塑后其5年期死亡率达30%。病因学和病理生理机制目前尚不明确。阻塞性呼吸暂停（OSA）在心血管病患者中发病率达50%，但在全身性动脉粥样硬化的发病情况尚未阐明。

为进一步明确OSA与PAD病人预后的关系，芬兰一研究小组研究了腹股沟下血管成形术后PAD患者的OSA流行病学表现。82例窦性心律且无充血性左心衰或未诊断过OSA的患者（平均年龄67±9，52名男性）接受了多道睡眠扫描和超声心动图检查，其中OSA有70例（85%）（95% CI 75-93%），严重 OSA24例 (34%) 。大多数OSA无症状，根据性别和年龄调整的多变量回归分析显示其与肥胖、代谢综合征或其他动脉粥样硬化的现象无关，仅有左室射血分数(p=0.002)和高密度脂蛋白与总胆固醇比率(p=0.03)是OSA严重程度的独立预测因素。

因此，PAD患者中OSA发病率很高，与肥胖或代谢综合征或传统的OSA综合征表现无关。
与呼吸暂停相关的拓展阅读：

• Eur Respir J：女性人群中睡眠呼吸暂停的相关研究
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• Chest:限盐饮食或可缓解睡眠呼吸暂停
• 睡眠呼吸暂停综合征患者脑损伤有性别差异
• HEART RHYTHM:阻塞性睡眠呼吸暂停升高房颤消融后复发率
• 从心脑血管病角度看睡眠呼吸暂停低通气综合征
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Unrecognised obstructive sleep apnoea is common in severe peripheral arterial disease.
Abstract
Patients needing surgery for peripheral arterial disease (PAD) represent a severe form of atherosclerosis with an overall 5-yr mortality of 30% after revascularisation. The aetiology for poor post-operative clinical outcome in these high-risk patients is not fully established. Obstructive sleep apnoea (OSA) is associated with atherosclerosis and is an independent risk factor for fatal and nonfatal cardiac events. Here, we determine the prevalence of undiagnosed OSA in a homogenous group of PAD patients undergoing subinguinal surgical revascularisation. 82 consecutive patients (mean age 67±9 yrs, 52 males) with sinus rhythm and without congestive heart failure or previously diagnosed OSA were enrolled for pre-operative polysomnography and echocardiography. OSA was present in 70 (85%) patients (95% CI 75-93%), of whom 24 (34%) had severe OSA. OSA was mostly asymptomatic, and age- and sex-adjusted multivariate regression analysis showed no relation to obesity, metabolic syndrome or any manifestation of atherosclerosis, other than PAD. Left ventricular ejection fraction (p = 0.002) and high-density lipoprotein/total cholesterol ratio (p = 0.03) were the only independent predictors for the severity of OSA. Thus, prevalence of OSA is unexpectedly high in patients with PAD and is not related to classical risk factors of sleep apnoea.