Gaines Jordan, Kong Lan, Li Menghan, Fernandez-Mendoza Julio, Bixler Edward O, Basta Maria, Vgontzas Alexandros N
Department of Psychiatry, Sleep Research and Treatment Center Pennsylvania State University College of Medicine, Hershey, Pennsylvania.
Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.
Physiol Rep. 2017 Sep;5(18). doi: 10.14814/phy2.13454.
Obstructive sleep apnea (OSA), particularly in the mild-to-moderate range, affects up to 40% of the adult general population. While it is clear that treatment should be pursued in severe cases of OSA, when and how to best treat OSA in the mild-to-moderate range remains complicated, despite its high prevalence. The aim of this study was to compare the relative utility of apnea/hypopnea index (AHI) versus a biomarker of inflammation, C-reactive protein (CRP), in identifying the presence and severity of hypertension and hyperglycemia. Middle-aged ( = 60) adults with mild-to-moderate OSA (AHI between 5 and 29 events per hour) underwent 8-h polysomnography, a physical examination including measures of blood pressure and body mass index, and a fasting morning blood draw for glucose and CRP CRP levels were associated with greater odds for having hypertension and hyperglycemia compared to AHI Receiver-operating characteristics (ROC) curves revealed that adding CRP to standard clinical factors (age, sex, and BMI) yielded moderately good to strong risk models for the disorders (AUC = 0.721 and AUC = 0.813, respectively). These preliminary findings suggest that including a measure of CRP improves the ability for clinicians to detect cases of mild-to-moderate OSA with true cardiometabolic risk, with implications in improving prognosis and treatment within this clinically gray area.
阻塞性睡眠呼吸暂停(OSA),尤其是轻度至中度范围的OSA,影响着高达40%的成年普通人群。虽然很明显重度OSA病例应进行治疗,但对于轻度至中度范围的OSA何时以及如何进行最佳治疗仍然很复杂,尽管其患病率很高。本研究的目的是比较呼吸暂停/低通气指数(AHI)与炎症生物标志物C反应蛋白(CRP)在识别高血压和高血糖的存在及严重程度方面的相对效用。患有轻度至中度OSA(AHI为每小时5至29次事件)的中年(年龄≥60岁)成年人接受了8小时的多导睡眠监测、包括血压和体重指数测量的体格检查,以及空腹晨血葡萄糖和CRP检测。与AHI相比,CRP水平与患高血压和高血糖的几率更高相关。受试者工作特征(ROC)曲线显示,将CRP添加到标准临床因素(年龄、性别和BMI)中可产生对这些疾病的中度良好至强风险模型(AUC分别为0.721和0.813)。这些初步发现表明,纳入CRP测量可提高临床医生检测具有真正心脏代谢风险的轻度至中度OSA病例的能力,这对改善这一临床灰色区域内的预后和治疗具有重要意义。