事件加权去饱和负荷与睡眠呼吸暂停中的心血管死亡率：来自大型社区前瞻性队列的发现。
Event-Weighted Desaturation Burden and Cardiovascular Mortality in Sleep Apnoea: Findings from a Large Community-Based Prospective Cohort.
文献信息
| PMID | 42860838 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Zhihua Huang |
| 作者单位 | Center for Respiratory and Pulmonary Vascular Diseases, Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China. |
| 期刊 | European journal of preventive cardiology |
| SCI 分区 | Q1 |
| IF | 9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
背景与目的： 阻塞性睡眠呼吸暂停的预后价值因依赖呼吸暂停-低通气指数（AHI）而受限，AHI无法捕捉呼吸事件的生理异质性。我们开发了一种复合指标——事件加权去饱和负荷（EWDB），整合了加权呼吸事件负荷、连续事件间期规律性以及累积去饱和面积。我们评估了其与心血管死亡率的关联，以及与AHI和已确立的低氧指标相比的增量预后价值。
方法： 我们分析了睡眠心脏健康研究中4,904名成年人，其具有基线多导睡眠监测和裁定随访。EWDB通过结合呼吸加权指数、基于事件间期规律性的分布因子以及事件相关低氧负荷（HB）得出。
结果： 主要结局为心血管死亡率。在中位随访约11年期间，发生341例心血管死亡。在完全调整的多变量Cox模型中，较高的EWDB与心血管死亡率独立相关。然而，AHI和HB的关联在完全调整后减弱并失去统计学显著性。EWDB（每增加1个标准差）仍与心血管死亡率稳健相关，而AHI则不然。将EWDB纳入综合临床模型可提供增量风险分层。对于致死性冠心病和 incident 心力衰竭也观察到类似的稳健关联。
结论： 在该队列中，EWDB与心血管死亡率独立相关，并在已确立的临床和睡眠相关因素之外提供了增量预后信息。通过整合呼吸事件强度、累积负荷和事件间期规律性，EWDB可能更好地表征与睡眠呼吸障碍相关的心血管应激。
英文摘要
BACKGROUND AND AIMS: Obstructive sleep apnoea's prognostic value is limited by reliance on the apnoea-hypopnoea index (AHI), which fails to capture physiological heterogeneity of respiratory events. We developed a composite metric, event-weighted desaturation burden (EWDB), integrating weighted respiratory event load, regularity of consecutive inter-event intervals, and cumulative desaturation area. We evaluated its association with cardiovascular mortality and its incremental prognostic value compared with AHI and established hypoxic metrics.
METHODS: We analysed 4,904 adults from the Sleep Heart Health Study with baseline polysomnography and adjudicated follow-up. EWDB was derived by combining a respiratory weighted index, a distribution factor based on inter-event interval regularity, and event-linked hypoxic burden (HB).
RESULTS: The primary outcome was cardiovascular mortality. Over a median follow-up of approximately 11 years, 341 cardiovascular deaths occurred. In fully adjusted multivariable Cox models, higher EWDB was independently associated with cardiovascular mortality. However, AHI and HB associations were attenuated and lost statistical significance after full adjustment. EWDB (per 1-SD increase) remained robustly associated with cardiovascular mortality, whereas AHI did not. Incorporating EWDB into a comprehensive clinical model provided incremental risk stratification. Similar robust associations were observed for fatal coronary heart disease and incident heart failure.
CONCLUSIONS: EWDB was independently associated with cardiovascular mortality and provided incremental prognostic information beyond established clinical and sleep-related factors in this cohort. By integrating respiratory event intensity, cumulative burden, and inter-event interval regularity, EWDB may better characterize cardiovascular stress related to sleep-disordered breathing.