STOP-BANG問卷在心房顫動患者中篩查阻塞性睡眠呼吸暫停綜合征的應(yīng)用研究

STOP-BANG問卷在心房顫動患者中篩查阻塞性睡眠呼吸暫停綜合征的應(yīng)用研究STOP-BANG問卷在心房顫動患者中篩查阻塞性睡眠呼吸暫停綜合征的應(yīng)用研究

摘要：隨著人們生活水平的提高，阻塞性睡眠呼吸暫停綜合征(OSA)的發(fā)病率不斷上升。心房顫動(AF)是一種常見的心律失常，與OSA密切相關(guān)。本研究旨在探討STOP-BANG問卷在AF患者中篩查OSA的應(yīng)用價值。本研究共納入80例AF患者，按照STOP-BANG問卷評估標(biāo)準(zhǔn)分為高危組和低危組，同時進行特發(fā)性心房顫動(AF)問題調(diào)查表、國際睡眠阻塞性呼吸暫停綜合征評估表的評估。結(jié)果顯示，高危組檢出OSA的比例明顯高于低危組，篩查出改善OSA后AF的總有效率達到了80%以上。本研究表明STOP-BANG問卷可在AF患者中準(zhǔn)確預(yù)測OSA的出現(xiàn)，并可以開展OSA干預(yù)治療，有望為防治AF提供新思路。

關(guān)鍵詞：STOP-BANG問卷；阻塞性睡眠呼吸暫停綜合征；心房顫動；篩查

Introduction：阻塞性睡眠呼吸暫停綜合征(OSA)是一種常見的夜間呼吸紊亂，嚴(yán)重的OSA患者常常出現(xiàn)晝夜疲倦、失眠、高血壓等各種并發(fā)癥。研究顯示，心房顫動(AF)是OSA的常見危險因素之一。雖然安裝呼吸機等設(shè)備可以緩解OSA，但是早期篩查和有效干預(yù)治療對于患者預(yù)后影響更為大。本研究評價STOP-BANG問卷對AF患者OSA篩查的性能和臨床效果，為早期廣泛應(yīng)用提供基礎(chǔ)數(shù)據(jù)。

Methods：本研究選擇了80名心房顫動(AF)患者，按照篩查標(biāo)準(zhǔn)將其分為高危組和低危組。同時，進行特發(fā)性心房顫動(AF)問題調(diào)查表、國際睡眠阻塞性呼吸暫停綜合征評估表的評估。高危組患者進一步接受二級多導(dǎo)睡眠監(jiān)測檢查(OSA定義為呼吸暫停低于或等于15次/小時)。高危組試驗病人采用喉罩或口罩通氣器進行治療，睡眠監(jiān)測反饋分析睡眠效果。

Results：高危組檢出OSA的比例明顯高于低危組，篩查出改善OSA后AF的總有效率達到了80%以上。同時性別、BMI、舌根等因素與OSA密切相關(guān)。結(jié)論：STOP-BANG問卷是一種簡單、快速且易操作的篩查工具。通過止鼾和口腔口罩等多種干預(yù)手段，可以有效緩解患者的OSA，同時也可以顯著地改善AF的治療效果，在臨床上具有廣闊的應(yīng)用前景。

Conclusion：STOP-BANG問卷是一個可靠的篩查工具，可準(zhǔn)確預(yù)測OSA在AF患者中的出現(xiàn)。通過干預(yù)治療OSA，有效改善AF的預(yù)后，有望成為患者篩查和干預(yù)治療的實用工具Introduction：Obstructivesleepapnea(OSA)isacommoncomorbidityinpatientswithatrialfibrillation(AF),whichcannegativelyimpacttheprognosis.ThisstudyevaluatedtheperformanceandclinicaleffectivenessoftheSTOP-BANGquestionnaireinscreeningOSAinAFpatients,providingbaselinedataforitsearlyandwidespreadapplication.

Methods:Thisstudyselected80AFpatientsandclassifiedthemintohigh-andlow-riskgroupsaccordingtoscreeningcriteria.Atthesametime,evaluationswereconductedusingthevalidatedquestionnairesforidiopathicAFproblemsandtheInternationalClassificationofSleepDisorders.High-riskgrouppatientsunderwentlevelIIpolysomnography(OSAdefinedasrespiratoryevents≤15/h).Thehigh-risktrialpatientsweretreatedwithanasopharyngealororalmaskventilationdeviceandsleepmonitoringfeedbacktoanalyzethesleepeffect.

Results:TheproportionofOSAdetectedinthehigh-riskgroupwassignificantlyhigherthanthatinthelow-riskgroup,andthetotaleffectivenessofimprovingAFafterOSAimprovementreachedmorethan80%.Meanwhile,factorssuchasgender,BMI,andtonguebasewerecloselyrelatedtoOSA.Conclusion:TheSTOP-BANGquestionnaireisasimple,fast,andeasy-to-operatescreeningtool.Throughvariousinterventionssuchasanti-snoringandoralmask,itcaneffectivelyalleviatepatients'OSA,andalsosignificantlyimprovethetreatmenteffectofAF,withbroadclinicalapplicationprospects.

Conclusion:TheSTOP-BANGquestionnaireisareliablescreeningtoolthatcanaccuratelypredicttheoccurrenceofOSAinAFpatients.BytreatingOSAandeffectivelyimprovingtheprognosisofAF,itisexpectedtobecomeapracticaltoolforpatientscreeningandinterventionInadditiontotheinterventionsmentionedabove,lifestylechangescanalsoplayacrucialroleinthemanagementofOSAandAF.Forinstance,weightloss,regularexercise,andavoidanceofalcoholandsedativescanhelpalleviateOSAsymptomsandimprovehearthealth.Moreover,CPAPtherapy,whichinvolveswearingamaskthatdeliversairpressuretokeeptheairwayopenduringsleep,isoftenrecommendedasafirst-linetreatmentforpatientswithmoderatetosevereOSA.StudieshaveshownthatCPAPtherapynotonlyreducesOSAsymptomsbutalsodecreasesbloodpressure,improvesleftventricularfunction,andreducestheriskofAFrecurrence.

However,despitethepotentialbenefitsofCPAPtherapy,patientadherencecanbeachallenge.Manypatientsfindthemaskuncomfortable,andsomemayexperienceclaustrophobia,drymouth,ornasalcongestion.Therefore,healthcareprovidersshouldworkcloselywithpatientstoidentifyandaddressanybarrierstoadherence,andprovideeducationandsupporttohelppatientsuseCPAPeffectively.

Inconclusion,OSAandAFoftencoexistandcanhaveasynergisticeffectoneachother,leadingtoworseoutcomesandhigherhealthcarecosts.TheSTOP-BANGquestionnaireisausefultoolforidentifyingOSAinAFpatients,enablinghealthcareproviderstoimplementappropriateinterventionsandimprovepatientoutcomes.However,furtherresearchisneededtobetterunderstandtheunderlyingmechanismslinkingOSAandAF,andtodevelopmoreeffectivetreatmentstrategiesthattakeintoaccounttheuniqueneedsandpreferencesofindividualpatientsObstructivesleepapnea(OSA)isacommonsleepdisorderwithsignificanthealthimplications,includingcardiovasculardisease,hypertension,andstroke.OSAhasalsobeenassociatedwithatrialfibrillation(AF),themostcommonformofcardiacarrhythmia.AFischaracterizedbyanirregularheartbeatthatcanleadtobloodclots,stroke,andheartfailure.ThecoexistenceofOSAandAFcanhaveacompoundingeffectoneachother,leadingtoworseoutcomesandhigherhealthcarecosts.

TheprevalenceofOSAinAFpatientshasbeenestimatedtobeashighas49-83%,dependingonthepopulationstudiedandtheseverityofOSAcriteriaused.OSAisasignificantriskfactorforthedevelopmentandprogressionofAF.PatientswithOSAhavebeenfoundtohavea2-3timesincreasedriskofdevelopingAFcomparedtothosewithoutOSA.Inaddition,patientswithbothOSAandAFhaveahigherriskofcardiovascularevents,suchasstrokeandheartfailure,comparedtothosewithAFalone.

TheexactmechanismsunderlyingthelinkbetweenOSAandAFarenotfullyunderstood.OneproposedmechanismisthattheintermittenthypoxiaandsympatheticactivationassociatedwithOSAcanleadtostructuralandelectricalchangesintheheartthatpromoteAF.OSAmayalsoexacerbateexistingcardiacabnormalitiesandpredisposetoAFthroughinflammationandoxidativestress.

ThediagnosisofOSAinAFpatientsisimportantforboththemanagementofAFandthepreventionofassociatedcardiovascularcomplications.TheSTOP-BANGquestionnaireisausefultoolforidentifyingOSAinAFpatients.TheSTOP-BANGquestionnaireconsistsofeightitems:snoring,tiredness,observedapnea,highbloodpressure,bodymassindex(BMI),age,neckcircumference,andgender.Ascoreof3ormoreindicatesahighriskofOSA.TheuseoftheSTOP-BANGquestionnairehasbeenshowntoimprovethedetectionofOSAinAFpatients,leadingtobettermanagementofbothconditions.

TreatmentofOSAinAFpatientsisessentialforimprovingoutcomesandreducinghealthcarecosts.Continuouspositiveairwaypressure(CPAP)isthemosteffectivetreatmentforOSA,andhasbeenshowntoimproveAFoutcomesinpatientswithmoderatetosevereOSA.However,adherencetoCPAPtherapycanbechallengingforsomepatientsduetoissuessuchasdiscomfort,noise,andclaustrophobia.OthertreatmentoptionsforOSA,suchasmandibularadvancementdevicesandsurgery,maybeconsideredinselectedpatients.

Inconclusion,thecoexistenceofOSAandAFiscommonandcanhaveasignificantimpactonpatientoutcomesandhealthcarecosts.TheuseoftheSTOP-BANGquestionnaireisausefultoolforidentifyingOSAinAFpatients,enablinghealthcareproviderstoimplementappropriateinterventionsandimprovepatientoutcomes.Furt