The Treatment Of Cardiovascular Disease-related Obstructive Sleep Apnea-hypopnea Syndrome And The Construction And Verification Of In-hospital Death Scores For Women With Myocardial Infarction

Part Ⅰ:The Prognosis of Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea Hypopnea SyndromeBackground and Objectives:Obstructive sleep apnea hypopnea syndrome(OSAHS)is one of the most common sleep disorders and relevant to the prognosis of cardiovascular and cerebrovascular disease.Continuous positive airway pressure(CPAP)is the first-line therapy for patients with more than moderate OSAHS.It is controversial whether CPAP has a positive effect on the prognosis of patients with OSAHS.We conducted this study to investigate the impact of CPAP treatment on the long-term outcome for patients with OSAHS.Methods:The study was performed among 154 patients who were younger than 75 years old with moderate or severe OSAHS between September 2009 and September 2014.They were divided into treatment group(n=66)and control group(n=88),based on whether they underwent long-term CPAP treatment or not.The efficacy of CPAP treatment was evaluated by long-term clinical observation.Results:The median follow-up time was 32 months.The incidence of death,myocardial infarction,coronary revascularization and stroke events was 1.5%in CPAP treatment group and 11.4%in control group(P<0.05).The CPAP treatment group had a lower incidence of coronary heart disease,arrhythmia,heart failure,cardiomyopathy,peripheral vascular disease,diabetes and hyperlipidaemia events than the control group(22.7%vs.40.9%,P<0.05).Conclusions:CPAP treatment could reduce cardiovascular events risk for patients with OSAHS and improve long-term prognosis.Part II:Effect of Continuous positive airway pressure on patients with moderate to severe obstructive sleep apnea syndrome and hypertensionBackground and Objectives:As indicated in the guidelines and published studies,Obstructive sleep apnea hypopnea syndrome(OSAHS)is associated with hypertension.The patients with hypertension and OSAHS have a higher risk of cardiovascular events than that without OSAHS.It is controversial whether Continuous positive airway pressure(CPAP)has a positive effect on blood pressure control.We conducted this study to examine the effect of CPAP on blood pressure in patients with moderate to severe OSAS and hypertension in China.Methods:117 hypertensive patients who were younger than 75 years old with moderate to severe OSAHS between 2010 and 2015 were recruited.The 117 patients were divided into the CPAP group(treated by regular antihypertensive drugs and CPAP treatment,n=52),and the control group(treated only by regular antihypertensive drugs,n=65).The regular follow-up was performed every 3 months.Blood pressure changes were evaluated between the two groups.Results:The median follow-up time was 30 months.The apnea-hypopnea index(AHI)and the oxygen desaturation index(ODI)were higher in CPAP group.Apart from the proportion of patients with diabetes,there was no difference in baseline of the patients between the two groups.The decrease of the systolic blood pressure in the CPAP group[(12.6±18.1)mm Hg]was significantly greater than that in the control group[(4.5± 16.8)mm Hg,P=0.02],while the decrease of the diastolic blood pressure had no significant difference between the two groups[(10.0±12.4)vs(6.9±15.0)mm Hg,P=0.23].In addition,the percent of patients who needed to add extra kinds of antihypertensive drugs in the CPAP treatment group was significantly lower than that in the control group(2.0%vs 20.3%,P<0.01).Conclusions:CPAP could further decrease systolic blood pressure in patients with moderate to severe OSAS and hypertension on the basis of medication.Part Ⅲ:Development and Validation of Women Acute Myocardial Infarction in-Hospital Mortality Score(WAMI Score)Background and objectives:A variety of risk models have been developed to predict acute myocardial infarction(AMI)in-hospital mortality risk.As a distinct,higher-risk population,women with AMI have different risk profiles from their men counterparts.Published researches have indicated that the interaction between variables in these models for in-hospital mortality and gender are significant.Due to the interaction and gender differences,the predicting value of these risk models for women could be controversial.Methods:Databases from the China Patient-centered Evaluative Assessment of Cardiac Events(China PEACE)Retrospective AMI Study were utilized for model derivation(n=16,100,women were 4,896)and databases from the China PEACE Prospective AMI Study for model validation(n=6,207,women were 2,090).A multivariable backward stepwise logistic regression was used to examine correlates of in-hospital mortality,and the variables were subsequently weighted and integrated into a scoring system.Results:We constructed a novel risk-predicting tool to estimate the baseline risk of in-hospital mortality among women with AMI.The risk score includes 8 variables[age,systolic blood pressure,heart rate,initial glomerular filtration rate(GFR),serum glucose,Killip class,cardiac arrest,ventricular tachycardia/ventricular fibrillation(VT/VF)].The prognostic discriminatory capacity of the WAMI risk score was excellent(c statistic 0.84,95%confidence interval[CI]:0.83 to 0.86,p<0.001).External validation of the model showed better prognostic capacity(c statistic 0.87,95%CI:0.84 to 0.90,p<0.001)than the GRACE risk score(0.77,95%CI 0.72-0.82,p<0.001)and TIMI risk score(0.72,95%CI 0.68-0.77,p<0.001).Conclusions:The WAMI score is a simple robust tool for predicting the in-hospital mortality risk of women with AMI.