1 Division of Sleep and Circadian Disorders and.
2 Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Colchester, Vermont.
Ann Am Thorac Soc. 2018 Aug;15(8):970-977. doi: 10.1513/AnnalsATS.201802-121OC.
The association between obstructive sleep apnea (OSA) and cardiovascular disease (CVD) is complex, bidirectional, and may vary across groups. Understanding which cardiovascular risk factors vary in their relationship to OSA across population groups may improve knowledge of OSA-related CVD susceptibility.
To better understand the heterogeneity of associations, we assessed whether associations of OSA with cardiovascular risk factors vary by age, sex, and race/ethnicity.
We performed cross-sectional analyses of 1,344 Multi-Ethnic Study of Atherosclerosis participants who underwent overnight full polysomnography, assays of fasting blood, and assessments of cardiovascular risk factors. Risk factors considered were blood pressure, glucose/lipid concentrations, white blood cell (WBC) total and subset counts, and cystatin C. The outcome was the apnea-hypopnea index (AHI). Linear regression analyses with tests for interactions were conducted.
The sample had a mean age of 68 ± 9 years. Forty-seven percent of the sample was male, and 32% had moderate or severe OSA (AHI, ≥15). Multivariable adjusted analysis showed significant associations between higher AHI with lower high-density lipoprotein cholesterol and higher diastolic blood pressure and neutrophil counts. Significant interactions with demographic factors were observed. Stronger associations were shown between AHI and higher total WBC count (P = 0.006) and glucose concentrations (P = 0.006) in younger (<65 yr) than in older individuals, higher triglyceride concentrations in men than in women (P = 0.006), and higher total WBC (P = 0.07) and monocyte counts (P = 0.03) in African American individuals than in other racial groups.
In a multiethnic cohort, we found increased levels of cardiovascular risk factors in association with OSA, including elevated neutrophil counts, a marker of inflammation. Furthermore, several associations were stronger in men, younger individuals, and African American individuals, highlighting pathways for CVD risk that may explain heterogeneity in the associations between CVD and OSA across population groups.
阻塞性睡眠呼吸暂停（OSA）与心血管疾病（CVD）之间的关联是复杂的、双向的，并且可能因人群而异。了解心血管危险因素与 OSA 之间的关联在不同人群中的变化，可能有助于提高对 OSA 相关 CVD 易感性的认识。
为了更好地理解这种异质性，我们评估了 OSA 与心血管危险因素的关联是否因年龄、性别和种族/民族而不同。
我们对接受过夜全睡眠多导睡眠图、空腹血液检测和心血管危险因素评估的 1344 名多民族动脉粥样硬化研究参与者进行了横断面分析。考虑的危险因素包括血压、血糖/血脂浓度、白细胞（WBC）总数和亚群计数以及胱抑素 C。结局是呼吸暂停低通气指数（AHI）。进行了线性回归分析，并进行了交互检验。
该样本的平均年龄为 68±9 岁。样本中有 47%为男性，32%患有中度或重度 OSA（AHI≥15）。多变量调整分析显示，较高的 AHI 与较低的高密度脂蛋白胆固醇和较高的舒张压和中性粒细胞计数呈显著相关。与人口统计学因素的显著交互作用。在较年轻（<65 岁）的个体中，AHI 与总白细胞计数（P=0.006）和血糖浓度（P=0.006）的相关性更强，在男性中与甘油三酯浓度的相关性更强（P=0.006）与其他种族群体相比，在非洲裔美国人中，总白细胞计数（P=0.07）和单核细胞计数（P=0.03）更高。
在一个多民族队列中，我们发现与 OSA 相关的心血管危险因素水平升高，包括升高的中性粒细胞计数，这是炎症的标志物。此外，在男性、年轻个体和非洲裔美国人中，一些关联更强，这突出了可能解释 CVD 和 OSA 之间关联在不同人群中异质性的 CVD 风险途径。
