A long-term ischemic stroke risk score model in patients aged 60 years and older with obstructive sleep apnea: a multicenter prospective cohort study.
10.12122/j.issn.1673-4254.2022.03.04
- Author:
Xiao Feng SU
1
;
Ji Ming HAN
2
;
Ying Hui GAO
3
;
Li FAN
4
;
Zi Jun HE
2
;
Zhe ZHAO
1
;
Jun Ling LIN
5
;
Jing Jing GUO
6
;
Kai Bing CHEN
7
;
Yan GAO
8
;
Lin LIU
1
Author Information
1. Department of Pulmonary and Critical Care Medicine, Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China.
2. Medical School of Yan'an University, Yan'an 716000, China.
3. PKU-UPenn Sleep Center, Peking University International Hospital, Beijing 102206, China.
4. Department of Cardiology, Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China.
5. Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100020, China.
6. Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing 100013, China.
7. Sleep Center, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou 730000, China.
8. Department of General Practice, 960th Hospital of PLA, Jinan 250031, China.
- Publication Type:Randomized Controlled Trial
- Keywords:
ModeL;
elderly;
ischemic stroke;
obstructive sleep apnea;
risk prediction
- MeSH:
Aged;
Humans;
Ischemic Stroke;
Middle Aged;
Prospective Studies;
Risk Factors;
Sleep;
Sleep Apnea, Obstructive/complications*;
Stroke/complications*
- From:
Journal of Southern Medical University
2022;42(3):338-346
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE:To analyze the independent risk factors of long-term ischemic stroke and establish a nomogram for predicting the long-term risks in elderly patients with obstructive sleep apnea (OSA).
METHODS:This multicenter prospective cohort study was conducted from January, 2015 to October, 2017 among consecutive elderly patients (≥60 years) with newly diagnosed OSA without a history of cardio-cerebrovascular diseases and loss of important clinical indicators. The follow-up outcome was the occurrence of ischemic stroke. The baseline demographic and clinical data, sleep parameters, laboratory and ultrasound results were collected from all the patients, who were randomized into the modeling group (n=856) and validation group (n=258) at a 3∶1 ratio. LASSO regression was used for variable reduction and dimension screening, and the risk score prediction model of ischemic stroke was established based on Cox proportional hazard regression.
RESULTS:In the total of 1141 patients enrolled in this study, 58 (5.08%) patients experienced ischemic stroke during the median follow-up of 42 months (range 41-54 months). The cumulative incidence of ischemic stroke was 5.14% in the model group and 4.91% in the verification group (P < 0.05). Age (HR=3.44, 95% CI: 2.38- 7.77), fasting blood glucose (FPG) (HR=2.13, 95% CI: 1.22-3.72), internal diameter of the ascending aorta (HR=2.60, 95% CI: 1.0- 4.47), left atrial anteroposterior diameter (HR=1.98, 95% CI: 1.75-2.25) and minimum oxygen saturation (LSpO2) (HR=1.57, 95% CI: 1.20-1.93) were identified as independent risk factors for ischemic stroke (P < 0.05 or 0.01). A long-term ischemic stroke risk score model was constructed based the regression coefficient ratios of these 5 risk variables. Before and after the application of the Bootstrap method, the AUC of the cohort risk score model was 0.84 (95% CI: 0.78- 0.90) and 0.85 (95% CI: 0.78- 0.89) in the model group and was 0.83 (95% CI: 0.73-0.93) and 0.82 (95%CI: 0.72-0.90) in the verification group, respectively, suggesting a good prediction efficiency and high robustness of the model. At the best clinical cutoff point, the cumulative incidence of ischemic stroke was significantly higher in the high-risk group than in the low-risk group (P=0.021).
CONCLUSION:This model can help to identify high-risk OSA patients for early interventions of the risks of ischemic stroke associated with OSA.
