阻塞性睡眠呼吸暂停（OSA）患者心血管疾病常见预测因素之间的相互关系：一项大规模观察性研究。
Interrelationships among common predictors of cardiovascular diseases in patients of OSA: A large-scale observational study.
机构信息
Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, 200233 Shanghai, China; Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, 200233 Shanghai, China; Shanghai Key Laboratory of Sleep Disordered Breathing, China.
Institute of Neuroscience, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Yueyang Road 320, 200031 Shanghai, China.
出版信息
Nutr Metab Cardiovasc Dis. 2020 Jan 3;30(1):23-32. doi: 10.1016/j.numecd.2019.07.016. Epub 2019 Aug 9.
BACKGROUND AND AIMS
The apolipoprotein B/apolipoprotein A-I (ApoB/ApoA-I) and insulin resistance has been recognized as common cardiovascular diseases (CVD) risk factors. However, whether they were biomarkers for 10-year CVD risk in obstructive sleep apnea (OSA) had been rarely studied. Besides, interrelationships between the ApoB/ApoA-I, insulin resistance and OSA remain unclear.
METHODS AND RESULTS
A total of 4010 subjects were finally included. Anthropometric, fasting biochemical, and polysomnographic parameters were collected. 10-year Framingham CVD risk score (FRS) was calculated for each subjects. The relationships between insulin resistance, OSA risk and the ApoB/ApoA-I was evaluated through logistic regressions analysis, restricted cubic spline (RCS) analysis and mediation analysis. ApoB/ApoA-I, HOMA-IR and AHI were all risk factors for high10-year CVD risk as assessed by FRS (odds ratios (OR) = 5.365, 1.094, 1.010, respectively, all P < 0.001)). The fully adjusted OR (95% confidence intervals) for both OSA [1 (reference), 1.308 (1.027-1.665), 1.517 (1.178-1.953), and 1.803 (1.371-2.372)] and insulin resistance [1 (reference), 1.457 (1.173-1.711), 1.701 (1.369-2.113), 2.051(1.645-2.558)] increased from the first to the fourth quartiles of the ApoB/ApoA-I. The RCS mapped a nonlinear dose-effect relationship between the ApoB/ApoA-I and risk of insulin resistance and OSA. Mediation analyses showed HOMA-IR explain 9.7%, 4.7% and 10.8% of the association between apnea-hypopnea index, oxygen desaturation index, micro-arousal index and ApoB/ApoA-I, respectively.
CONCLUSIONS
Our study revealed that ApoB/ApoA-I, insulin resistance and OSA were risk factors for CVD. Insulin resistance may serve as a potential mediator in OSA-related lipoprotein disorders and further increase CVD risk.
背景和目的
载脂蛋白 B/载脂蛋白 A-I（ApoB/ApoA-I）和胰岛素抵抗已被认为是常见的心血管疾病（CVD）危险因素。然而，它们是否是阻塞性睡眠呼吸暂停（OSA）患者 10 年 CVD 风险的生物标志物尚未得到广泛研究。此外，ApoB/ApoA-I、胰岛素抵抗和 OSA 之间的相互关系仍不清楚。
方法和结果
共纳入 4010 名受试者。收集了人体测量学、空腹生化和多导睡眠图参数。为每位受试者计算了 10 年Framingham CVD 风险评分（FRS）。通过逻辑回归分析、限制性三次样条（RCS）分析和中介分析评估了胰岛素抵抗、OSA 风险与 ApoB/ApoA-I 之间的关系。ApoB/ApoA-I、HOMA-IR 和 AHI 均为 FRS 评估的高 10 年 CVD 风险的危险因素（比值比（OR）=5.365、1.094、1.010，均 P<0.001））。OSA 的完全调整 OR（95%置信区间）[1（参考），1.308（1.027-1.665），1.517（1.178-1.953），1.803（1.371-2.372）]和胰岛素抵抗[1（参考），1.457（1.173-1.711），1.701（1.369-2.113），2.051（1.645-2.558）]从 ApoB/ApoA-I 的第一四分位到第四四分位依次增加。RCS 绘制了 ApoB/ApoA-I 与胰岛素抵抗和 OSA 风险之间的非线性剂量-效应关系图。中介分析表明，HOMA-IR 分别解释了呼吸暂停-低通气指数、氧减指数、微觉醒指数与 ApoB/ApoA-I 之间关联的 9.7%、4.7%和 10.8%。
结论
我们的研究表明，ApoB/ApoA-I、胰岛素抵抗和 OSA 是 CVD 的危险因素。胰岛素抵抗可能是 OSA 相关脂蛋白紊乱的潜在中介，并进一步增加 CVD 风险。
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