阻塞性睡眠呼吸暫停與射頻消融術(shù)后心房顫動(dòng)復(fù)發(fā)關(guān)系的Meta分析

屈園園++++++余鋰鐳++++++江洪

[摘要] 目的 系統(tǒng)評(píng)價(jià)阻塞性睡眠呼吸暫停（OSA）與射頻消融術(shù)后心房顫動(dòng)（AF）復(fù)發(fā)的關(guān)系，為消融術(shù)后AF復(fù)發(fā)的病因探索提供依據(jù)。 方法 計(jì)算機(jī)檢索PubMed、Embase、Cochrane圖書(shū)館、中國(guó)期刊全文數(shù)據(jù)庫(kù)、維普數(shù)據(jù)庫(kù)、萬(wàn)方數(shù)據(jù)庫(kù)關(guān)于OSA與射頻消融術(shù)后AF復(fù)發(fā)的隊(duì)列研究，采用RevMan 5.2軟件進(jìn)行Meta分析。 結(jié)果 納入10篇隊(duì)列研究，共計(jì)1571例患者。Meta分析結(jié)果顯示：OSA組術(shù)后AF復(fù)發(fā)的風(fēng)險(xiǎn)顯著高于對(duì)照組（RR = 1.36，95%CI：1.25～1.48，P < 0.01）。按OSA診斷方法分組，亞組分析示，柏林問(wèn)卷組的術(shù)后復(fù)發(fā)風(fēng)險(xiǎn)（RR = 1.46，95%CI：1.31～1.63，P < 0.01）高于多導(dǎo)睡眠監(jiān)測(cè)儀組（RR = 1.28，95%CI：1.13～1.45，P = 0.0001）。 結(jié)論 患OSA的AF患者行導(dǎo)管消融術(shù)后AF復(fù)發(fā)的風(fēng)險(xiǎn)較對(duì)照組高，OSA是消融術(shù)后AF復(fù)發(fā)的危險(xiǎn)因素。

[關(guān)鍵詞] 阻塞性睡眠呼吸暫停；心房顫動(dòng)；射頻消融；Meta分析

[中圖分類(lèi)號(hào)] R56；R541.75 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1673-7210（2015）10（b）-0008-05

Meta-analysis on association between obstructive sleep apnea and atrial fibrillation recurrence after cather ablation

QU Yuanyuan YU Lilei JIANG Hong▲

Department of Cardiology， Renmin Hospital of Wuhan University， Hubei Province， Wuhan 430060， China

[Abstract] Objective To review systematically the association between obstructive sleep apnea （OSA） and atrial fibrillation （AF） recurrence after cather ablation， and to provide evidence for etiological research of AF recurrence after cather ablation. Methods The databases of PubMed， Embase， Cochrane library， CNKI， VIP Database and Wanfang Database were retrieved for selecting cohort studies about OSA and AF recurrence after cather ablation. A Meta-analysis was performed by RevMan 5.2 software. Results Ten cohort studies were included with a total of 1571 patients. The results of Meta-analysis showed that risk of AF recurrence after cather ablation in patients with OSA was significantly higher than that in control group （RR = 1.36， 95%CI： 1.25-1.48， P < 0.01）. Studies were grouped according to different diagnostic tools for OSA， and subgroup analysis showed that risk of AF recurrence after cather ablation in OSA diagnosed by Berlin questionnaire （BQ） （RR = 1.46， 95%CI： 1.31-1.63， P < 0.01） was higher than that in OSA diagnosed by polysomnography （RR = 1.28， 95%CI： 1.13-1.45， P = 0.0001）. Conclusion Patients with OSA have a greater risk of AF recurrence than those without OSA. OSA is a risk factor of AF recurrence after cather ablation.

[Key words] Obstructive sleep apnea； Atrial fibrillation； Cather ablation； Meta-analysis

阻塞性睡眠呼吸暫停（OSA）是由睡眠中上呼吸道反復(fù)塌陷所致，引起一系列生理變化，最終導(dǎo)致包括心律失常在內(nèi)的心血管疾病發(fā)病風(fēng)險(xiǎn)增加[1]。心房顫動(dòng)（AF）是OSA患者中最常見(jiàn)的一種心律失常[2]。對(duì)于AF患者，射頻消融術(shù)的運(yùn)用越來(lái)越廣泛，但術(shù)后復(fù)發(fā)是臨床工作者必須考慮的問(wèn)題。國(guó)內(nèi)外對(duì)OSA是否影響消融術(shù)后AF復(fù)發(fā)進(jìn)行了多項(xiàng)臨床研究，但得到的結(jié)論不一致。本文就兩者關(guān)系進(jìn)行討論。

1 資料與方法

1.1 文獻(xiàn)納入和排除標(biāo)準(zhǔn)

1.1.1 研究對(duì)象 患有OSA、擬行射頻消融的AF患者。診斷OSA的方法包括多導(dǎo)睡眠監(jiān)測(cè)儀和柏林問(wèn)卷（BQ）。

1.1.2 暴露因素 暴露組為患OSA的AF患者，對(duì)照組為相應(yīng)的未患OSA的AF患者。