Zeng Fanfang, Wang Xiang, Hu Wei, Wang Lili
Department of Cardiology, Shenzhen Sun Yat-sen Cardiovascular Hospital, Shenzhen, Guangdong Province, China.
Medicine (Baltimore). 2017 Aug;96(32):e7784. doi: 10.1097/MD.0000000000007784.
Obstructive sleep apnea (OSA) is prevalent in obese subjects. Plasma adiponectin level in obese subjects is decreased. Whether reduced adiponectin level is associated with OSA is unknown. Participants without a previous diagnosis of OSA or who have not been treated with continuous positive airway pressure were enrolled and parameters of interest were collected. Polysomnography was performed to evaluate the presence of OSA and the severity of OSA as indexed by the apnea-hypopnea index (AHI). Between-group differences were analyzed. Pearson correlation analysis was used to evaluate the association between body mass index (BMI) with plasma levels of adiponectin and C-reactive protein (CRP) and AHI; and the association between plasma adiponectin level with CRP and AHI was also evaluated. Logistic regression analysis was conducted to evaluate the association between per 1-SD standardized decrease of plasma adiponectin level and the prevalence of OSA using stepwise adjustment models. A total of 486 participants were enrolled and the mean BMI was 26.9 ± 6.2 kg/m with obesity prevalence of 28%; and the mean AHI was 12.6 ± 8.9 per sleep hour with OSA prevalence of 42%. The mean adiponectin level was 18.4 ± 10.6 μg/mL. Compared with the nonobese group, participants in the obese group had higher BMI, neck girth, waist circumference, and AHI (P < .05 for all comparisons). The prevalence of OSA (51% vs 37%) and the proportion of moderate OSA (49% vs 42%) were also significantly higher, while adiponectin level (14.6 ± 8.7 μg/mL vs 20.7 ± 10.5 μg/mL) was significantly lower. In the obese group, plasma adiponectin level was decreased gradually with the increasing severity of OSA, which was not observed in the nonobese group. BMI was negatively correlated with adiponectin while positively correlated with CRP and AHI; and adiponectin was negatively correlated with both CRP and AHI. After adjusted for covariates including BMI and waist circumference, adiponectin remained significantly associated with OSA prevalence with odds ratio of 1.20 (95% confidence interval 1.12-1.65). In summary, our preliminary study suggests that in obese subjects, plasma adiponectin level is associated with the prevalence of OSA.
阻塞性睡眠呼吸暂停（OSA）在肥胖受试者中很常见。肥胖受试者的血浆脂联素水平降低。脂联素水平降低是否与OSA相关尚不清楚。招募未既往诊断为OSA或未接受持续气道正压通气治疗的参与者，并收集相关参数。进行多导睡眠图检查以评估OSA的存在情况以及以呼吸暂停低通气指数（AHI）为指标的OSA严重程度。分析组间差异。采用Pearson相关分析评估体重指数（BMI）与血浆脂联素水平、C反应蛋白（CRP）水平及AHI之间的相关性；同时评估血浆脂联素水平与CRP及AHI之间的相关性。采用Logistic回归分析，使用逐步调整模型评估血浆脂联素水平每降低1个标准差与OSA患病率之间的相关性。共招募了486名参与者，平均BMI为26.9±6.2kg/m²，肥胖患病率为28%；平均AHI为每睡眠小时12.6±8.9次，OSA患病率为42%。平均脂联素水平为18.4±10.6μg/mL。与非肥胖组相比，肥胖组参与者的BMI、颈围、腰围和AHI更高（所有比较P<0.05）。OSA患病率（51%对37%）和中度OSA比例（49%对42%）也显著更高，而脂联素水平（14.6±8.7μg/mL对20.7±10.5μg/mL）显著更低。在肥胖组中，血浆脂联素水平随着OSA严重程度的增加而逐渐降低，非肥胖组未观察到这种情况。BMI与脂联素呈负相关，与CRP和AHI呈正相关；脂联素与CRP和AHI均呈负相关。在调整包括BMI和腰围在内的协变量后，脂联素与OSA患病率仍显著相关，比值比为1.20（95%置信区间1.12 - 1.65）。总之，我们的初步研究表明，在肥胖受试者中，血浆脂联素水平与OSA患病率相关。
