心率骤升在睡眠呼吸暂停中改善心血管风险分层，其价值超越缺氧负荷
Heart Rate Surge Improves Cardiovascular Risk Stratification Beyond Hypoxic Burden in Sleep Apnea.
文献信息
| PMID | 42909449 |
|---|---|
| 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, China. |
| 期刊 | JACC. Asia |
| 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（OSA）通过间歇性缺氧和事件相关反应造成心血管应激。心率骤升是否在缺氧负荷（HB）之外提供预后信息仍不清楚。
目的： 作者旨在评估心率骤升与心血管死亡的关系及其在OSA中超越HB的增量价值。
方法： 我们分析了来自社区队列的4,790名接受整夜多导睡眠监测的参与者。心率骤升定义为事件对齐窗口内的峰值心率减去事件前60秒基线的平均心率。使用Cox模型评估与心血管死亡的关联。通过C指数、净重分类改善（NRI）和综合判别改善评估增量预后价值。
结果： 在中位随访11.6年（IQR：10.4-12.4）期间，334/4,790名参与者（7.0%）死于心血管原因。心率骤升与HB呈弱相关（Spearman ρ = 0.08；95% CI：0.04-0.10）。最高与最低心率骤升五分位相比与更高的心血管死亡风险相关（HR：3.00；95% CI：2.10-4.30；P < 0.001），每增加1个SD与风险增加27%相关（HR：1.27；95% CI：1.19-1.35）。HB和心率骤升均升高的参与者风险最高（HR：2.65；95% CI：1.79-3.92）。加入心率骤升使C指数从0.77（95% CI：0.74-0.79）提高到0.81（95% CI：0.79-0.83），ΔC为0.04（95% CI：0.03-0.06），连续NRI为0.62（95% CI：0.51-0.74），分类NRI为0.16（95% CI：0.09-0.24），综合判别改善为0.05（95% CI：0.04-0.06）。
结论： 在OSA中，心率骤升与心血管死亡独立相关，并在HB之外改善了风险分层。
英文摘要
BACKGROUND: Obstructive sleep apnea (OSA) imposes cardiovascular stress through intermittent hypoxia and event-related responses. Whether heart rate surge adds prognostic information beyond hypoxic burden (HB) remains unclear.
OBJECTIVES: The authors aimed to evaluate heart rate surge for cardiovascular mortality and its incremental value beyond HB in OSA.
METHODS: We analyzed 4,790 participants from a community-based cohort with overnight polysomnography. Heart rate surge was defined as peak heart rate within the event-aligned window minus mean heart rate during the 60-second pre-event baseline. Associations with cardiovascular mortality were assessed using Cox models. Incremental prognostic value was evaluated by C-index, net reclassification improvement (NRI), and integrated discrimination improvement.
RESULTS: During a median follow-up of 11.6 years (IQR: 10.4-12.4), 334/4,790 participants (7.0%) died of cardiovascular causes. Heart rate surge was weakly correlated with HB (Spearman ρ = 0.08; 95% CI: 0.04-0.10). The highest vs lowest heart rate surge quintile was associated with higher cardiovascular mortality risk (HR: 3.00; 95% CI: 2.10-4.30; P < 0.001) and each 1-SD increment was associated with a 27% higher risk (HR: 1.27; 95% CI: 1.19-1.35). Participants with elevated HB and heart rate surge had the highest risk (HR: 2.65; 95% CI: 1.79-3.92). Adding heart rate surge increased the C-index from 0.77 (95% CI: 0.74-0.79) to 0.81 (95% CI: 0.79-0.83), with ΔC of 0.04 (95% CI: 0.03-0.06), continuous NRI of 0.62 (95% CI: 0.51-0.74), categorical NRI of 0.16 (95% CI: 0.09-0.24), and integrated discrimination improvement of 0.05 (95% CI: 0.04-0.06).
CONCLUSIONS: Heart rate surge was independently associated with cardiovascular mortality and improved risk stratification beyond HB in OSA.