阻塞性睡眠呼吸暂停与肺栓塞：患病率、严重程度及睡眠呼吸障碍与血栓栓塞性疾病的关联

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中文摘要

背景/目的： 阻塞性睡眠呼吸暂停（OSA）与肺栓塞（PE）共享若干危险因素，而新出现的证据提示，在这些共同决定因素之外，二者可能存在潜在的病理生理联系。我们旨在描述急性PE患者中OSA的患病率和严重程度，并探讨呼吸暂停低通气指数（AHI）是否与PE及其临床病程独立相关。方法：在这项前瞻性、单中心、病例对照研究中，128例连续急性PE患者和252例患有其他呼吸系统疾病的门诊对照接受了家庭呼吸多导描记。在PE患者中，睡眠检查在急性事件后至少三个月进行。OSA依据国际共识标准进行诊断和分级。采用logistic回归模型评估AHI与PE、急性PE严重程度、慢性深静脉血栓形成（DVT）及静脉血栓栓塞症（VTE）复发之间的关联。结果：PE患者中OSA的患病率为55.5%，其中重度OSA为28.9%，而对照组分别为42.1%和13.9%（p = 0.013和p = 0.001）。PE患者的AHI更高（21.21 ± 19.29 vs. 14.81 ± 14.26次/小时；p = 0.007），氧减饱和度指数也更高（19.86 ± 18.77 vs. 13.30 ± 13.79；p = 0.003）。在调整年龄、性别、BMI和已确立的VTE危险因素后，AHI每增加10次/小时与PE独立相关（OR 1.205，95% CI 1.019-1.426；p = 0.029）。AHI与中高危/高危PE或慢性DVT无独立关联。在停用抗凝治疗的患者中，伴有OSA者的VTE复发率更高（36.0% vs. 13.3%；p = 0.049）。结论：OSA在急性PE患者中高度流行且常为重度。AHI升高与PE的存在独立相关，支持睡眠呼吸障碍与血栓栓塞性疾病之间具有临床相关性的关联。由于在PE明确缓解后未系统重新评估OSA，因此无法确定OSA是否独立于残余血栓栓塞性疾病而持续存在。OSA与停用抗凝治疗后复发性VTE之间观察到的关联能否在更大规模的前瞻性研究中得到证实，仍有待确定。

英文摘要

Background/Objectives: Obstructive sleep apnea (OSA) and pulmonary embolism (PE) share several risk factors, while emerging evidence suggests a potential pathophysiological link beyond these common determinants. We aimed to characterize the prevalence and severity of OSA in patients with acute PE and to investigate whether the apnea-hypopnea index (AHI) is independently associated with PE and its clinical course. Methods: In this prospective, single-center, case-control study, 128 consecutive patients with acute PE and 252 outpatient controls with other respiratory diseases underwent home respiratory polygraphy. In patients with PE, the sleep study was performed at least three months after the acute event. OSA was diagnosed and graded according to international consensus criteria. Logistic regression models were used to evaluate associations between AHI and PE, acute PE severity, chronic deep vein thrombosis (DVT), and venous thromboembolism (VTE) recurrence. Results: OSA was present in 55.5% of patients with PE, with severe OSA in 28.9%, compared with 42.1% and 13.9%, respectively, among controls (p = 0.013 and p = 0.001). Patients with PE had a higher AHI (21.21 ± 19.29 vs. 14.81 ± 14.26 events/h; p = 0.007) and oxygen desaturation index (19.86 ± 18.77 vs. 13.30 ± 13.79; p = 0.003). Each 10-events/h increase in AHI was independently associated with PE after adjustment for age, sex, BMI, and established VTE risk factors (OR 1.205, 95% CI 1.019-1.426; p = 0.029). AHI was not independently associated with intermediate-high/high-risk PE or chronic DVT. Among patients who discontinued anticoagulation, VTE recurrence was higher in those with OSA (36.0% vs. 13.3%; p = 0.049). Conclusions: OSA is highly prevalent and frequently severe in patients with acute PE. Increasing AHI is independently associated with the presence of PE, supporting a clinically relevant association between sleep-disordered breathing and thromboembolic disease. Because OSA was not systematically reassessed after documented resolution of PE, persistence of OSA independently of residual thromboembolic disease cannot be definitively established. Whether the observed association between OSA and recurrent VTE after anticoagulation withdrawal is confirmed in larger prospective studies remains to be determined.