接受阻塞性睡眠呼吸暂停手术患者的共病失眠：全国性队列中的临床特征与术后结局
Comorbid insomnia in patients undergoing surgery for obstructive sleep apnea: Clinical profile and postoperative outcomes in a nationwide cohort.
文献信息
| PMID | 42822394 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Pedro Gomes de Oliveira |
| 作者单位 | Department of Otolaryngology-Head and Neck Surgery, Division Sleep Surgery, Stanford School of Medicine, Stanford, CA, United States. Electronic address: pedromgo@stanford.edu. |
| 期刊 | Sleep medicine |
| SCI 分区 | Q1 |
| IF | 4.5 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
引言： 共病失眠与阻塞性睡眠呼吸暂停（COMISA）在接受手术的人群中仍未被充分描述。我们比较了接受上气道手术的COMISA患者与单纯OSA患者的基线特征和术后结局。
方法： 使用Apollo电子健康记录和索赔数据集（2015-2024）进行的回顾性队列研究。接受上气道手术的成人OSA患者，如果术前记录了失眠，则被归类为COMISA。两组均以手术日期为索引。通过排除基线时已有结局的患者，将结局限制为新发事件。在倾向评分匹配后，对5个预设模型进行了评估，随访3年（医疗保健利用为1年）。使用精确条件方法估计比值比。
结果： 在3292名成人中，863名（26.2%）有记录的失眠。与2429名单纯OSA患者相比，他们的抑郁或焦虑患病率翻倍（61.5% vs 30.6%），抗抑郁药使用率（51.4% vs 27.6%）和慢性疼痛（25.1% vs 12.4%）也更高，并且年龄更大、合并症更多。匹配后，COMISA患者在三年内开始抗抑郁治疗的概率更高（26.9% vs 6.0%；OR 5.71，95% CI 1.73-24.7；未调整OR 2.38，1.31-4.33）。在物质使用障碍、全身症状、睡眠相关运动障碍或医疗保健利用方面未观察到差异（门诊就诊IRR 0.99，0.86-1.15）。
结论： COMISA识别出一种独特的术前表型，具有更高的精神科和躯体疾病负担。除了抗抑郁药启动（其效应量估计不确定）外，这种负担并未转化为更差的术后结局或增加的医疗利用。这项观察性分析无法评估手术疗效，且可能存在残余混杂。
英文摘要
INTRODUCTION: Comorbid insomnia and obstructive sleep apnea (COMISA) remains undercharacterized in surgical populations. We compared baseline profiles and postoperative outcomes in patients with COMISA versus OSA alone undergoing upper airway surgery.
METHODS: Retrospective cohort study using the Apollo electronic health record and claims dataset (2015-2024). Adults with OSA undergoing upper airway surgery were classified as COMISA if insomnia was documented beforehand. Both groups were indexed at the surgical date. Outcomes were restricted to incident events by excluding patients with the outcome at baseline. Five prespecified models were evaluated after propensity-score matching over 3 years (1 year for healthcare utilization). Odds ratios were estimated with exact conditional methods.
RESULTS: Of 3292 adults, 863 (26.2%) had documented insomnia. Compared with 2429 patients with OSA alone, they had double the prevalence of depression or anxiety (61.5% vs 30.6%), antidepressant use (51.4% vs 27.6%) and chronic pain (25.1% vs 12.4%), and were older with higher comorbidity. After matching, patients with COMISA had higher odds of initiating antidepressant therapy within three years (26.9% vs 6.0%; OR 5.71, 95% CI 1.73-24.7; unadjusted OR 2.38, 1.31-4.33). No differences were observed for substance use disorders, constitutional symptoms, sleep-related movement disorders or healthcare utilization (office visits IRR 0.99, 0.86-1.15).
CONCLUSIONS: COMISA identifies a distinct preoperative phenotype with greater psychiatric and somatic morbidity. This burden did not translate into worse postoperative outcomes or increased utilization, apart from antidepressant initiation, an estimate of uncertain magnitude. This observational analysis cannot assess surgical efficacy, and residual confounding is possible.