中国循证医学杂志

中国循证医学杂志

阻塞性睡眠呼吸暂停低通气综合征对冠心病患者房颤风险影响的系统评价

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目的 系统评价阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对冠心病患者房颤发病风险的影响。 方法 计算机检索 PubMed、EMbase、The Cochrane Library、CNKI、WanFang Data 和 VIP 数据库,搜集 OSAHS 与冠心病或冠状动脉旁路移植术后房颤风险关系的队列研究,检索时限均从建库至 2018 年 7 月 2 日。由两名研究者独立筛选文献、提取资料、评价纳入研究的偏倚风险后,采用 RevMan 5.3 软件进行 Meta 分析。 结果 最终纳入 11 个队列研究,包括 709 例 OSAHS 患者和 975 例非 OSAHS 患者。Meta 分析结果显示:OSAHS 明显增加冠心病患者房颤的发病风险[RR=2.01,95%CI(1.72,2.36),P<0.000 01]。亚组分析结果显示:① 采用多导睡眠监测(PSG)诊断的冠心病合并 OSAHS 患者发生房颤的风险增加[RR=2.40,95%CI(1.84,3.12),P<0.000 01],其中冠心病合并中重度 OSAHS 患者发生房颤的风险更高[RR=3.73,95%CI(2.51,5.53),P<0.000 01];② 采用柏林问卷调查(BQ)评估的冠心病合并高风险 OSAHS 患者发生房颤的风险也比冠心病合并低风险 OSAHS 患者有所增加[RR=1.56,95%CI(1.27,1.92),P<0.000 1]。 结论 现有证据表明,合并 OSAHS 明显增加冠心病患者房颤的发病风险。受纳入研究质量和数量的限制,上述结论尚需开展大规模高质量的研究予以验证。

Objective To systematically review whether or not obstructive sleep apnea hypopnea syndrome (OSAHS) increases the incidence of atrial fibrillation in coronary artery disease patients. Methods PubMed, EMbase, The Cochrane Library, CNKI, VIP, WanFang Data databases were searched for studies on the relationship between OSAHS and the incidence of atrial fibrillation in coronary artery disease patients from inception to July 2nd, 2018. Two reviewers independently screened literatures, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was administrated by RevMan 5.3 software. Results In total, 11 cohort studies were included. They included 709 exposed groups and 975 non-exposed groups. The results of meta-analysis indicated that OSAHS was associated with the incidence of atrial fibrillation in coronary artery disease patients (RR=2.01, 95%CI 1.72 to 2.36, P<0.000 01). The subgroup analysis showed that OSAHS of PSG diagnosis increased the risk of the incidence of atrial fibrillation in coronary artery disease patients (RR=2.40, 95%CI 1.84 to 3.12,P<0.000 01); moderate and severe OSAHS of PSG diagnosis had higher risk of the incidence of atrial fibrillation in coronary artery disease patients (RR=3.73, 95%CI 2.51 to 5.53,P<0.000 01); high risk OSAHS of Berlin questionnaire assessment increased the incidence of atrial fibrillation in CAD patients (RR=1.56, 95%CI 1.27 to 1.92,P<0.000 1). Conclusion The current evidence indicates that OSAHS is associated with an increased risk of atrial fibrillation in coronary artery disease patients. Due to the limitation of quality and quantity of the included studies, more large-scale and fine quality research will be needed to warrant the accuracy of conclusions above.

关键词: 阻塞性睡眠呼吸暂停低通气综合征; 心房颤动; 冠心病; 队列研究; Meta 分析

Key words: Obstructive sleep apnea hypopnea syndrome; Atrial fibrillation; Coronary artery disease; Cohort study; Meta-analysis

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