Li Taomei, Covassin Naima, Tan Lu, Ren Rong, Zhang Ye, Lei Fei, Yang Linghui, Zhou Junying, Sun Hongqiang, Somers Virend K, Tang Xiangdong
Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Translational Neuroscience Center, State Key Laboratory, West China Hospital, Sichuan University, Chengdu, China.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
J Clin Sleep Med. 2020 Jul 15;16(7):1063-1072. doi: 10.5664/jcsm.8398.
Hypoxemic effects of obstructive sleep apnea (OSA) have been implicated in changes in erythropoiesis and hence erythrocyte measures. Sex differences are evident in both OSA and erythropoiesis. Whether sex modulates the relationship between severity of OSA and erythrocyte measures has not previously been studied.
We examined a sample of 976 patients (38% women) who underwent overnight polysomnography and measurement of red blood cell count, hemoglobin, and hematocrit. Patients were divided into primary snoring and mild, moderate, and severe OSA groups, separately by sex.
In multiple regression models, we found significant interactions between sex and oxygen desaturation index and apnea-hypopnea index on erythrocyte measures. Higher oxygen desaturation index and higher apnea-hypopnea index were independently associated with higher red blood cell count, hemoglobin, and hematocrit in women but not in men. Further ordinal logistic regression analysis showed a significant association between oxygen desaturation index (odds ratio, 2.33; 95% confidence interval, 1.17-4.66) and apnea-hypopnea index (odds ratio, 2.44; 95% confidence interval, 1.23-4.84) and red blood cell count in women only. Correlation analysis also showed that erythrocyte measures and markers of cardiometabolic risk were more closely correlated in women than in men.
This study provides novel data suggesting a significant association between erythrocyte measures and OSA severity in women but not in men. Similarly, the relationship between hematologic metrics and cardiometabolic risk markers was more pronounced in women than in men. Our findings suggest a sex-specific impact of OSA on erythrocyte measures and on their relationship with indexes of cardiometabolic risk.
阻塞性睡眠呼吸暂停（OSA）的低氧血症效应与红细胞生成变化及红细胞指标有关。OSA和红细胞生成在性别上均存在差异。此前尚未研究性别是否会调节OSA严重程度与红细胞指标之间的关系。
我们对976例患者（38%为女性）进行了研究，这些患者接受了夜间多导睡眠监测，并测量了红细胞计数、血红蛋白和血细胞比容。患者按性别分别分为原发性打鼾组以及轻度、中度和重度OSA组。
在多元回归模型中，我们发现性别与氧饱和度下降指数及呼吸暂停低通气指数之间在红细胞指标方面存在显著交互作用。较高的氧饱和度下降指数和较高的呼吸暂停低通气指数与女性较高的红细胞计数、血红蛋白和血细胞比容独立相关，但与男性无关。进一步的有序逻辑回归分析显示，仅在女性中，氧饱和度下降指数（比值比，2.33；95%置信区间，1.17 - 4.66）和呼吸暂停低通气指数（比值比，2.44；95%置信区间，1.23 - 4.84）与红细胞计数之间存在显著关联。相关性分析还表明，女性的红细胞指标与心脏代谢风险标志物之间的相关性比男性更密切。
本研究提供了新的数据，表明红细胞指标与女性OSA严重程度之间存在显著关联，而男性则不然。同样，血液学指标与心脏代谢风险标志物之间的关系在女性中比在男性中更明显。我们的研究结果表明，OSA对红细胞指标及其与心脏代谢风险指标的关系存在性别特异性影响。
