范肖雪,赵延延,王闯世,白银晓,王杨

• 1:国家心血管病中心北京协和医学院中国医学科学院阜外医院冠心病中心国家心血管病中心医学统计部

摘要(Abstract)：

目的 评估睡眠时长变短对行经皮冠状动脉介入治疗（PCI）冠心病患者术后发生再次血运重建事件的影响。方法 连续纳入中国医学科学院阜外医院冠心病中心16 948例接受PCI的注册登记患者，根据术后随访患者睡眠时长的变化分为睡眠时长较术前减少，即睡眠时长变短组（1 826例），其余患者为对照组（15 122例），主要研究终点为再次血运重建事件，通过多因素Cox回归探讨睡眠时长变短与再次血运重建事件的关系。结果 患者平均随访时间为（3.0±1.6）年，共1 563例（9.2%）患者发生再次血运重建，其中睡眠时长变短组216例（11.8%），对照组1 347例（8.9%），差异有统计学意义（P<0.001）。校正混杂因素后，与对照组相比，睡眠时长变短组患者发生再次血运重建事件的风险显著升高（HR 1.407,95%CI 1.217～1.627,P<0.001）。考虑死亡事件的竞争风险模型结果相似，显示睡眠时长变短组患者发生再次血运重建事件的风险更高（HR 1.404,95%CI 1.215～1.622,P<0.001）。对年龄、性别进行亚组分析，在高龄、低龄、男性、女性亚组人群中，与对照组相比，睡眠时长变短组患者发生再次血运重建事件的风险升高。结论 行PCI的冠心病患者术后睡眠时长变短与高再次血运重建发生风险有关。

关键词(KeyWords)： 睡眠时长变短;经皮冠状动脉介入治疗;再次血运重建

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 范肖雪,赵延延,王闯世,白银晓,王杨

参考文献(References)：

• [1]王丽敏，关云琦.睡眠状况与主要慢性病患病的关系[J].中华流行病学杂志，2020,41(8):1237-1241.DOI:10.3760/cma.j.cn112338-20200529-00788.
• [2]Hoevenaar-Blom MP,Spijkerman AM,Kromhout D,et al.Sleep duration and sleep quality in relation to 12-year cardiovascular disease incidence:the MORGEN study[J].Sleep,2011,34(11):1487-1492.DOI:10.5665/sleep.1382.
• [3]Itani O,Jike M,Watanabe N,et al.Short sleep duration and health outcomes:a systematic review,Meta-analysis and Meta-regression[J].Sleep Med,2017,32:246-256.DOI:10.1016/j.sleep.2016.08.006.
• [4]Januszek R,Bujak K,G?sior M,et al.Survival rate after acute myocardial infarction in patients treated with percutaneous coronary intervention within the left main coronary artery according to time of admission[J].Medicine(Baltimore),2021,100(4):e24360.DOI:10.1097/MD.0000000000024360.
• [5]Fernandes NM,Nield LE,Popel N,et al.Symptoms of disturbed sleep predict major adverse cardiac events after percutaneous coronary intervention[J].Can J Cardiol,2014,30(1):118-124.DOI:10.1016/j.cjca.2013.07.009.
• [6]Li L,Wang H,Wang Y,et al.Path analysis for key factors influencing long-term quality of life of patients following a percutaneous coronary intervention[J].Coron Artery Dis,2019,30(5):339-345.DOI:10.1097/MCA.0000000000000712.
• [7]Patt BT,Jarjoura D,Haddad DN,et al.Endothelial dysfunction in the microcirculation of patients with obstructive sleep apnea[J].Am J Respir Crit Care Med,2010,182(12):1540-1545.DOI:10.1164/rccm.201002-0162OC.
• [8]Ip MS,Tse HF,Lam B,et al.Endothelial function in obstructive sleep apnea and response to treatment[J].Am J Respir Crit Care Med,2004,169(3):348-353.DOI:10.1164/rccm.200306-767OC.
• [9]Von K?nel R,Loredo JS,Ancoli-Israel S,et al.Association between polysomnographic measures of disrupted sleep and prothrombotic factors[J].Chest,2007,131(3):733-739.DOI:10.1378/chest.06-2006.
• [10]Yumino D,Tsurumi Y,Takagi A,et al.Impact of obstructive sleep apnea on clinical and angiographic outcomes following percutaneous coronary intervention in patients with acute coronary syndrome[J].Am J Cardiol,2007,99(1):26-30.DOI:10.1016/j.amjcard.2006.07.055.
• [11]Steiner S,Schueller PO,Hennersdorf MG,et al.Impact of obstructive sleep apnea on the occurrence of restenosis after elective percutaneous coronary intervention in ischemic heart disease[J].Respir Res,2008,9(1):50.DOI:10.1186/1465-9921-9-50.
• [12]孙松枝.急性心肌梗死患者介入治疗后发生睡眠障碍的影响因素[J].河南医学研究，2022,31(19):3624-3627.DOI:10.3969/j.issn.1004-437X.2022.19.051.
• [13]沈迎，丁风华，张瑞岩，等.优化左心室收缩功能减退患者冠状动脉血运重建策略[J].中国介入心脏病学杂志，2022,30(9):641-643.DOI:10.3969/j.issn.1004-8812.2022.09.001.
• [14]赵帅，陈蓉，曹家豪，等.成功经皮冠状动脉介入治疗对冠状动脉慢性完全闭塞病变合并左心室射血分数降低患者生活质量的影响[J].中国介入心脏病学杂志，2022,30(4):259-264.DOI:10.3969/j.issn.1004-8812.2022.04.003.
• [15]王奕丹，代建南，房超，等.吸烟对急性ST段抬高型心肌梗死的影响[J].中国介入心脏病学杂志，2021,29(1):51-54.DOI:10.3969/j.issn.1004-8812.2021.01.011.
• [16]Fernandez-Mendoza J,Vgontzas AN,Liao D,et al.Insomnia with objective short sleep duration and incident hypertension:the Penn State Cohort[J].Hypertension,2012,60(4):929-935.DOI:10.1161/HYPERTENSIONAHA.112.193268.
• [17]Zhan Y,Chen R,Zhang F,et al.Insomnia and its association with hypertension in a community-based population in China:a cross-sectional study[J].Heart Asia,2014,6(1):88-93.DOI:10.1136/heartasia-2013-010440.
• [18]Hall MH,Muldoon MF,Jennings JR,et al.Self-reported sleep duration is associated with the metabolic syndrome in midlife adults[J].Sleep,2008,31(5):635-643.DOI:10.1093/sleep/31.5.635.
• [19]Spiegel K,Knutson K,Leproult R,et al.Sleep loss:a novel risk factor for insulin resistance and Type 2 diabetes[J].JAppl Physiol (1985),2005,99(5):2008-2019.DOI:10.1152/japplphysiol.00660.2005.
• [20]Morselli L,Leproult R,Balbo M,et al.Role of sleep duration in the regulation of glucose metabolism and appetite[J].Best Pract Res Clin Endocrinol Metab,2010,24(5):687-702.DOI:10.1016/j.beem.2010.07.005.
• [21]Ayas NT,White DP,Al-Delaimy WK,et al.A prospective study of self-reported sleep duration and incident diabetes in women[J].Diabetes Care,2003,26(2):380-384.DOI:10.2337/diacare.26.2.380.
• [22]Faraut B,Boudjeltia KZ,Vanhamme L,et al.Immune,inflammatory and cardiovascular consequences of sleep restriction and recovery[J].Sleep Med Rev,2012,16(2):137-149.DOI:10.1016/j.smrv.2011.05.001.
• [23]Spiegel K,Leproult R,Van Cauter E.Impact of sleep debt on metabolic and endocrine function[J].Lancet,1999,354(9188):1435-1439.DOI:10.1016/S0140-6736(99)01376-8.
• [24]Rauchenzauner M,Ernst F,Hintringer F,et al.Arrhythmias and increased neuro-endocrine stress response during physicians’night shifts:a randomized cross-over trial[J].Eur Heart J,2009,30(21):2606-2613.DOI:10.1093/eurheartj/ehp268.
• [25]李建华，陈莹恩，李燕.OSAHS对急性心肌梗死患者PCI术后疗效及预后的影响[J].中国循证心血管医学杂志，2022,14(9):1104-1106.DOI:10.3969/j.issn.1674-4055.2022.09.19.
• [26]Bin YS,Marshall NS,Glozier N.Sleeping at the limits:the changing prevalence of short and long sleep durations in 10countries[J].Am J Epidemiol,2013,177(8):826-833.DOI:10.1093/aje/kws308.
• [27]Cappuccio FP,Cooper D,D’Elia L,et al.Sleep duration predicts cardiovascular outcomes:a systematic review and Metaanalysis of prospective studies[J].Eur Heart J,2011,32(12):1484-1492.DOI:10.1093/eurheartj/ehr007.
• [28]Alvarez GG,Ayas NT.The impact of daily sleep duration on health:a review of the literature[J].Prog Cardiovasc Nurs,2004,19(2):56-59.DOI:10.1111/j.0889-7204.2004.02422.x.
• [29]Wang C,Bangdiwala SI,Rangarajan S,et al.Association of estimated sleep duration and naps with mortality and cardiovascular events:a study of 116 632 people from 21 countries[J].Eur Heart J,2019,40(20):1620-1629.DOI:10.1093/eurheartj/ehy695.