Ng Winda L, Orellana Liliana, Shaw Jonathan E, Wong Evelyn, Peeters Anna
Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Australia; School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Australia.
Sleep Med. 2017 Aug;36:109-118. doi: 10.1016/j.sleep.2017.05.004. Epub 2017 May 29.
Through a causal framework, we aim to assess the association between weight change and daytime sleepiness, and the role of obstructive sleep apnoea (OSA) in this relationship.
From the Sleep Heart Health Study, we selected individuals who were: (1) 40-64 years old, with (2) body mass index (BMI) ≥18.5 kg/m, (3) no history of stroke, treatment for OSA, and tracheostomy at baseline. We used multiple linear regression to assess the relationship between five-year weight change and daytime sleepiness (assessed through Epworth Sleepiness Scale (ESS)) at five years, adjusting for daytime sleepiness, demographics, diabetes, subjective sleep duration, sleep disturbance, smoking status, weight, and use of antidepressants and benzodiazepines at baseline, in those with complete data (N = 1468). We further assessed the potential mediating role of OSA in this relationship.
At baseline, the study participants were on average 55 years old, 46% males, with mean BMI 28 kg/m; and 25% had ESS>10. ESS at five years worsened by 0.36 units (95% confidence interval (CI) 0.12-0.61, p = 0.004) with every 10-kg weight gain. When stratified by sex, this relationship was only found in women (0.55, 95% CI 0.25-0.86, p < 0.001; p-interaction = 0.02). Approximately one-fifth of the relationship between weight change and daytime sleepiness was mediated by severity of OSA at five years.
Weight gain has a detrimental effect on daytime sleepiness, mostly through pathways other than OSA. This study provides further evidence and understanding of the relationship between obesity and excessive daytime sleepiness.
通过一个因果框架，我们旨在评估体重变化与日间嗜睡之间的关联，以及阻塞性睡眠呼吸暂停（OSA）在此关系中的作用。
从睡眠心脏健康研究中，我们选取了符合以下条件的个体：（1）年龄在40 - 64岁之间，（2）体重指数（BMI）≥18.5 kg/m²，（3）基线时无中风病史、OSA治疗史及气管造口术史。我们使用多元线性回归来评估五年体重变化与五年时日间嗜睡（通过爱泼华嗜睡量表（ESS）评估）之间的关系，在有完整数据的人群（N = 1468）中，对基线时的日间嗜睡、人口统计学特征、糖尿病、主观睡眠时间、睡眠障碍、吸烟状况、体重以及抗抑郁药和苯二氮䓬类药物的使用情况进行调整。我们进一步评估了OSA在此关系中的潜在中介作用。
在基线时，研究参与者平均年龄为55岁，46%为男性，平均BMI为28 kg/m²；25%的人ESS>10。每增加10千克体重，五年时的ESS恶化0.36个单位（95%置信区间（CI）0.12 - 0.61，p = 0.004）。按性别分层时，这种关系仅在女性中发现（0.55，95% CI 0.25 - 0.86，p < 0.001；p交互作用 = 0.02）。体重变化与日间嗜睡之间约五分之一的关系由五年时OSA的严重程度介导。
体重增加对日间嗜睡有不利影响，主要通过OSA以外的途径。本研究为肥胖与日间过度嗜睡之间的关系提供了进一步的证据和理解。
