Larkin Emma K, Rosen Carol L, Kirchner H Lester, Storfer-Isser Amy, Emancipator Judith L, Johnson Nathan L, Zambito Anna Marie V, Tracy Russell P, Jenny Nancy S, Redline Susan
Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Triangle Building Suite 260, 10400 Euclid Ave, Cleveland, OH 44106, USA.
Circulation. 2005 Apr 19;111(15):1978-84. doi: 10.1161/01.CIR.0000161819.76138.5E.
There is increasing evidence that sleep-disordered breathing (SDB) is an independent risk factor for cardiovascular disease (CVD) in adults. C-reactive protein (CRP), a marker of systemic inflammation, is an important predictor of future cardiovascular events. The goal of this study was to quantify the associations of SDB, sleep duration, and CRP in adolescents to better understand the role of SDB in CVD risk.
Adolescents (n=143; age, 13 to 18 years; 36% black; 50% female) with a wide range of SDB severity underwent polysomnography and measurement of high-sensitivity CRP. SDB was quantified with the apnea hypopnea index (AHI) and oxygen desaturation measures. Sleep duration was estimated from 7-day actigraphy. The independent and dose-response associations of SDB with CRP were addressed through linear mixed-effects models. Forty-eight percent were overweight or obese, and 12% had SDB (AHI > or =5). CRP levels varied with increasing body mass index and SDB. After adjustment for body mass index , age, sex, and race, mean CRP levels were 0.50, 0.43, 0.97, and 1.66 mg/L for SDB severity levels of AHI <1, 1 to 4.9, 5 to 14.9, and > or =15, respectively (P=0.0049, AHI > or =15 versus <1). Adjusted mean CRP levels demonstrated a dose response with SDB above a threshold AHI of 5. This association was partially explained by overnight hypoxemia and less so by sleep duration.
In adolescents free of known CVD, an AHI > or =5 is associated with increasing levels of CRP, suggesting that pediatric SDB may confer additional CVD risk beyond that of obesity.
越来越多的证据表明，睡眠呼吸紊乱（SDB）是成人心血管疾病（CVD）的独立危险因素。C反应蛋白（CRP）作为全身炎症的标志物，是未来心血管事件的重要预测指标。本研究的目的是量化青少年中SDB、睡眠时间和CRP之间的关联，以更好地了解SDB在CVD风险中的作用。
对患有各种严重程度SDB的青少年（n = 143；年龄13至18岁；36%为黑人；50%为女性）进行多导睡眠图检查和高敏CRP测量。通过呼吸暂停低通气指数（AHI）和氧饱和度测量来量化SDB。睡眠时间通过7天的活动记录仪进行估计。通过线性混合效应模型研究SDB与CRP的独立和剂量反应关系。48%的青少年超重或肥胖，12%患有SDB（AHI≥5）。CRP水平随体重指数和SDB的增加而变化。在调整体重指数、年龄、性别和种族后，AHI<1、1至4.9、5至14.9和≥15的SDB严重程度水平对应的平均CRP水平分别为0.50、0.43、0.97和1.66 mg/L（P = 0.0049，AHI≥15与 <1相比）。调整后的平均CRP水平在AHI阈值为5以上时显示出与SDB的剂量反应关系。这种关联部分由夜间低氧血症解释，而睡眠时间的影响较小。
在无已知CVD的青少年中，AHI≥5与CRP水平升高相关，这表明小儿SDB可能会带来超出肥胖之外的额外CVD风险。
