秘鲁四个资源有限地区的睡眠呼吸障碍：患病率、危险因素及与慢性病的关联
Sleep Disordered Breathing in Four Resource-Limited Settings in Peru: Prevalence, Risk Factors, and Association with Chronic Diseases.
作者信息
Schwartz Noah G, Rattner Adi, Schwartz Alan R, Mokhlesi Babak, Gilman Robert H, Bernabe-Ortiz Antonio, Miranda J Jaime, Checkley William
机构信息
Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD.
Pritzker School of Medicine, University of Chicago, Chicago, IL.
出版信息
Sleep. 2015 Sep 1;38(9):1451-9. doi: 10.5665/sleep.4988.
STUDY OBJECTIVES
Sleep disordered breathing (SDB) is a highly prevalent condition in high-income countries, with major consequences for cardiopulmonary health, public safety, healthcare utilization, and mortality. However, its prevalence and effect in low- and middle-income countries are less well known. We sought to determine the prevalence, risk factors, and comorbidities of SDB symptoms in four resource-limited settings.
DESIGN
Cross-sectional analysis of the CRONICAS Cohort, a population-based age- and sex-stratified sample.
SETTING
Four resource-limited settings in Peru varying in altitude, urbanization, and air pollution.
PARTICIPANTS
There were 2,682 adults aged 35 to 92 y.
MEASUREMENTS AND RESULTS
Self-reported SDB symptoms (habitual snoring, observed apneas, Epworth Sleepiness Scale), sociodemographics, medical history, anthropometrics, spirometry, blood biomarkers were reported. We found a high prevalence of habitual snoring (30.2%, 95% confidence interval [CI] 28.5-32.0%), observed apneas (20.9%, 95% CI 19.4-22.5%) and excessive daytime sleepiness (18.6%, 95% CI 17.1-20.1%). SDB symptoms varied across sites; prevalence and adjusted odds for habitual snoring were greatest at sea level, whereas those for observed apneas were greatest at high altitude. In multivariable analysis, habitual snoring was associated with older age, male sex, body mass index (BMI), and higher socioeconomic status; observed apneas were associated with BMI; and excessive daytime sleepiness was associated with older age, female sex, and medium socioeconomic status. Adjusted odds of cardiovascular disease, depression, and hypertension and total chronic disease burden increased progressively with the number of SDB symptoms. A threefold increase in the odds of having an additional chronic comorbid disease (adjusted odds ratio 3.57, 95% CI 2.18-5.84) was observed in those with all three versus no SDB symptoms.
CONCLUSIONS
Sleep disordered breathing symptoms were highly prevalent, varied widely across four resource-limited settings in Peru, and exhibited strong independent associations with chronic diseases.
研究目的
睡眠呼吸障碍（SDB）在高收入国家是一种高度流行的疾病，对心肺健康、公共安全、医疗利用和死亡率有重大影响。然而，其在低收入和中等收入国家的患病率及影响尚鲜为人知。我们试图确定四个资源有限地区SDB症状的患病率、危险因素和合并症。
设计
对CRONICAS队列进行横断面分析，该队列是一个基于人群的年龄和性别分层样本。
地点
秘鲁四个资源有限的地区，其海拔、城市化程度和空气污染情况各不相同。
参与者
2682名年龄在35至92岁之间的成年人。
测量与结果
报告了自我报告的SDB症状（习惯性打鼾、观察到的呼吸暂停、爱泼沃斯嗜睡量表）、社会人口统计学、病史、人体测量学、肺功能测定、血液生物标志物。我们发现习惯性打鼾的患病率很高（30.2%，95%置信区间[CI]28.5 - 32.0%），观察到的呼吸暂停患病率为20.9%（95%CI 19.4 - 22.5%），白天过度嗜睡患病率为18.6%（95%CI 17.1 - 20.1%）。SDB症状在不同地点有所不同；习惯性打鼾的患病率和调整后的比值在海平面地区最高，而观察到的呼吸暂停在高海拔地区最高。在多变量分析中，习惯性打鼾与年龄较大、男性、体重指数（BMI）和较高的社会经济地位相关；观察到的呼吸暂停与BMI相关；白天过度嗜睡与年龄较大、女性和中等社会经济地位相关。心血管疾病、抑郁症和高血压的调整后比值以及总的慢性病负担随着SDB症状的数量逐渐增加。在有所有三种SDB症状的人群与没有SDB症状的人群中，额外患有慢性合并症的几率增加了两倍（调整后的比值比为3.57，95%CI 2.18 - 5.84）。
结论
睡眠呼吸障碍症状非常普遍，在秘鲁四个资源有限的地区差异很大，并且与慢性疾病表现出强烈的独立关联。
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