OSA and Prognosis After Acute Cardiogenic Pulmonary Edema: The OSA-CARE Study.

Autor:	Uchôa CHG; Hypertension Unit, Cardiology Division, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil; Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil., Pedrosa RP; Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Brazil., Javaheri S; Bethesda North Hospital, University of Cincinnati College of Medicine, Cincinnati, OH, and Division of Cardiology, The Ohio State Medical School, Columbus, OH., Geovanini GR; Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil., Carvalho MMB; Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Brazil., Torquatro ACS; Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Brazil., Leite APDL; Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE) da Universidade de Pernambuco, Brazil., Gonzaga CC; Sleep Laboratory and Hypertension Unit, Dante Pazzanese Institute of Cardiology, Brazil., Bertolami A; Sleep Laboratory and Hypertension Unit, Dante Pazzanese Institute of Cardiology, Brazil., Amodeo C; Sleep Laboratory and Hypertension Unit, Dante Pazzanese Institute of Cardiology, Brazil., Petisco ACGP; Echocardiography Department, Dante Pazzanese Institute of Cardiology, Brazil., Barbosa JEM; Echocardiography Department, Dante Pazzanese Institute of Cardiology, Brazil., Macedo TA; Hypertension Unit, Cardiology Division, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil., Bortolotto LA; Hypertension Unit, Cardiology Division, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil., Oliveira MT Jr; Emergency Department, Cardiology Division, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil., Lorenzi-Filho G; Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil., Drager LF; Hypertension Unit, Cardiology Division, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil; Hypertension Unit, Nephrology Division, University of São Paulo Medical School, São Paulo, Brazil. Electronic address: luciano.drager@incor.usp.br.
Jazyk:	angličtina
Zdroj:	Chest [Chest] 2017 Dec; Vol. 152 (6), pp. 1230-1238. Date of Electronic Publication: 2017 Aug 16.
DOI:	10.1016/j.chest.2017.08.003
Abstrakt:	Background: Acute cardiogenic pulmonary edema (ACPE) is a life-threatening condition. OSA may be a modifiable risk factor for ACPE recurrence. This study was designed to evaluate the impact of OSA on the incidence of cardiovascular events following ACPE recovery. Methods: Consecutive patients with confirmed ACPE from 3 centers underwent a sleep study following clinical stabilization. OSA was defined as an apnea-hypopnea index (AHI) ≥ 15 events/h. The mean follow-up was 1 year, and the primary outcome was ACPE recurrence. Results: A total of 104 patients were included in the final analysis; 61% of the patients had OSA. A higher rate of ACPE recurrence (25 vs 6 episodes; P = .01) and a higher incidence of myocardial infarction (15 vs 0 episodes; P = .0004) were observed in patients with OSA than in those without OSA. All 17 deaths occurred in the OSA group (P = .0001). In a Cox proportional hazards regression analysis, OSA was independently associated with ACPE recurrence (hazard ratio [HR], 3.3 [95% CI, 1.2-8.8]; P = .01), incidence of myocardial infarction (HR, 2.3 [95% CI, 1.1-9.5]; P = .02), cardiovascular death (HR, 5.4 [95% CI, 1.4-48.4]; P = .004), and total death (HR, 6.5 [95% CI, 1.2-64.0]; P = .005). When the analysis was limited only to patients with OSA, levels of AHI and hypoxemic burden and rates of sleep-onset ACPE were significantly higher in those who presented with ACPE recurrence or who died than in those who did not experience these events. Conclusions: OSA is independently associated with higher rates of ACPE recurrence and both fatal and nonfatal cardiovascular events. (Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu