Pham Luu V, Miele Catherine H, Schwartz Noah G, Arias Rafael S, Rattner Adi, Gilman Robert H, Miranda J Jaime, Polotsky Vsevolod Y, Checkley William, Schwartz Alan R
Division of Pulmonary and Critical Care and Sleep Medicine, Dept of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
Division of Pulmonary and Critical Care and Sleep Medicine, Dept of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Eur Respir J. 2017 Jun 15;49(6). doi: 10.1183/13993003.01705-2016. Print 2017 Jun.
Associations between sleep disordered breathing (SDB) and cardiometabolic outcomes have not been examined in highlanders.We performed nocturnal polygraphy in Peruvian highlanders (3825 m). Multivariable linear regression models examined associations between SDB metrics and haemoglobin, glucose tolerance (haemoglobin A1c (HbA1c)), fasting glucose, homeostatic model-based assessments of insulin resistance and β-cell function (HOMA-IR and HOMA-β, respectively), blood pressure, and lipids, while adjusting for age, sex, body mass index (BMI) and wake oxygenation.Participants (n=187; 91 men) were (median (interquartile range)) 52 (45-62) years old, and had a BMI of 27.0 (24.3-29.5) kg·m and 87% (85-88%) oxyhaemoglobin (arterial oxygen) saturation during wakefulness. In fully adjusted models, worsening nocturnal hypoxaemia was associated with haemoglobin elevations in men (p=0.03), independent of wake oxygenation and apnoea-hypopnoea index (AHI), whereas worsening wake oxygenation was associated with haemoglobin elevations in older women (p=0.02). In contrast, AHI was independently associated with HbA1c elevations (p<0.05). In single-variable models, nocturnal hypoxaemia was associated with higher HbA1c, HOMA-IR and HOMA-β (p<0.001, p=0.02 and p=0.04, respectively), whereas AHI was associated with HOMA-IR, systolic blood pressure and triglyceride elevations (p=0.02, p=0.01 and p<0.01, respectively). These associations were not significant in fully adjusted models.In highlanders, nocturnal hypoxaemia and sleep apnoea were associated with distinct cardiometabolic outcomes, conferring differential risk for excessive erythrocytosis and glucose intolerance, respectively.
睡眠呼吸紊乱（SDB）与心血管代谢结局之间的关联尚未在高原人群中得到研究。我们对秘鲁高原地区（海拔3825米）的人群进行了夜间多导睡眠监测。多变量线性回归模型研究了SDB指标与血红蛋白、葡萄糖耐量（糖化血红蛋白（HbA1c））、空腹血糖、基于稳态模型的胰岛素抵抗和β细胞功能评估（分别为HOMA-IR和HOMA-β）、血压及血脂之间的关联，同时对年龄、性别、体重指数（BMI）和清醒时的氧合情况进行了校正。参与者（n = 187；91名男性）的年龄中位数（四分位间距）为52（45 - 62）岁，BMI为27.0（24.3 - 29.5）kg·m²，清醒时氧合血红蛋白（动脉血氧）饱和度为87%（85 - 88%）。在完全校正模型中，夜间低氧血症加重与男性血红蛋白升高相关（p = 0.03），独立于清醒时的氧合情况和呼吸暂停低通气指数（AHI），而清醒时氧合情况恶化与老年女性血红蛋白升高相关（p = 0.02）。相比之下，AHI与HbA1c升高独立相关（p < 0.05）。在单变量模型中，夜间低氧血症与更高的HbA1c、HOMA-IR和HOMA-β相关（分别为p < 0.001、p = 0.02和p = 0.04），而AHI与HOMA-IR、收缩压和甘油三酯升高相关（分别为p = 0.02、p = 0.01和p < 0.01）。在完全校正模型中，这些关联并不显著。在高原人群中，夜间低氧血症和睡眠呼吸暂停与不同的心血管代谢结局相关，分别导致红细胞增多症和葡萄糖不耐受的不同风险。
