持续气道正压通气对卒中合并阻塞性睡眠呼吸暂停患者左心房容积指数的影响：一项随机试验
Effect of Continuous Positive Airway Pressure on Left Atrial Volume Index in Patients With Stroke and Obstructive Sleep Apnea: A Randomized Trial.
文献信息
| PMID | 42786612 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Chou-Han Lin |
| 作者单位 | Division of Pulmonary Medicine, Department of Internal Medicine Far Eastern Memorial Hospital New Taipei City Taiwan. |
| 期刊 | Journal of the American Heart Association |
| SCI 分区 | Q1 |
| IF | 6.2 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
背景： 阻塞性睡眠呼吸暂停与左心房扩大相关，而左心房扩大是卒中的预测因素。我们假设持续气道正压通气（CPAP）可降低卒中合并阻塞性睡眠呼吸暂停患者的左心房容积指数（LAVI）并改变其纵向轨迹。
方法： 卒中合并阻塞性睡眠呼吸暂停患者被随机分配至标准治疗加CPAP组或单纯标准治疗组。共同主要结局为LAVI和N末端B型利钠肽原（NT-proBNP）的12个月绝对变化及纵向轨迹，在基线和3、6、12个月时评估。功能结局在3、6、12个月时评估。
结果： 共71名参与者被随机分组（35名CPAP，36名对照）。两组从基线至12个月LAVI均无显著变化，12个月LAVI变化的组间差异（对照-CPAP）无统计学意义（平均差0.5 mL/m2 [95% CI，-3.2至4.1 mL/m2]；P=0.804）。LAVI的线性混合效应模型显示显著的组×时间交互作用（P=0.005）。CPAP组NT-proBNP下降（P=0.029），但无组间差异。在完成随访的63名参与者中，观察到显著的二次交互作用，CPAP组LAVI轨迹向下，而对照组在6个月后轨迹向上（P=0.020）。12个月时改良Rankin量表为0分在CPAP组更常见（46.9%对22.6%；P=0.043）。
结论： 在卒中合并阻塞性睡眠呼吸暂停的参与者中，与对照相比，CPAP未显著降低12个月LAVI；然而，LAVI轨迹随时间出现分歧。在完成随访者中，CPAP组完全神经功能恢复更常见。
注册： 网址：https://www.clinicaltrials.gov；唯一标识符：NCT04458779。
英文摘要
BACKGROUND: Obstructive sleep apnea is associated with left atrial enlargement, a predictor of stroke. We hypothesized that continuous positive airway pressure (CPAP) would reduce the left atrial volume index (LAVI) and modify its longitudinal trajectory in patients with stroke and obstructive sleep apnea.
METHODS: Patients with stroke and obstructive sleep apnea were randomized to standard care plus CPAP or standard care alone. Coprimary outcomes were absolute 12-month change and longitudinal trajectories of LAVI and N-terminal pro-B-type natriuretic peptide (NT-proBNP), assessed at baseline and 3, 6, and 12 months. Functional outcomes were assessed at 3, 6, and 12 months.
RESULTS: Seventy-one participants were randomized (35 CPAP, 36 control). LAVI did not change significantly from baseline to 12 months in either group, and the between-group difference in 12-month LAVI change (control-CPAP) was nonsignificant (mean difference, 0.5 mL/m2 [95% CI, -3.2 to 4.1 mL/m2]; P=0.804). A linear mixed-effects model for LAVI revealed a significant group×time interaction (P=0.005). NT-proBNP declined in the CPAP group (P=0.029) without between-group differences. Among 63 participants who completed follow-up, a significant quadratic interaction was observed, with a downward LAVI trajectory in the CPAP group and an upward trajectory in controls after 6 months (P=0.020). A modified Rankin Scale of 0 at 12 months was more frequent with CPAP (46.9% versus 22.6%; P=0.043).
CONCLUSIONS: In participants with stroke and obstructive sleep apnea, CPAP did not significantly reduce 12-month LAVI compared with control; however, LAVI trajectories diverged over time. Among those who completed follow-up, complete neurologic recovery was more frequent with CPAP.
REGISTRATION: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT04458779.