Stevens David, Appleton Sarah, Vincent Andrew D, Melaku Yohannes, Martin Sean, Gill Tiffany, Hill Catherine, Vakulin Andrew, Adams Robert, Wittert Gary
Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
The Health Observatory, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.
Nat Sci Sleep. 2020 Nov 10;12:959-968. doi: 10.2147/NSS.S276932. eCollection 2020.
Reduced hand grip strength (HGS) is associated with poorer health in chronic conditions, yet there has been little research examining the association with hand grip strength and obstructive sleep apnea (OSA). Further, these studies have not examined, nor adjusted, for muscle mass. The aim of this study was to determine associations between OSA indices, HGS, muscle mass, and fat mass.
A total of 613 participants (age range 41-88, BMI 28.6 ± 4.3) from the population-based Men Androgen Inflammation Lifestyle Environment and Stress Study underwent in-home overnight polysomnography, assessment of dominant and non-dominant HGS, and dual x-ray absorptiometry to determine whole body muscle mass and fat mass. Linear models determined cross-sectional associations of polysomnographic-derived OSA indices with hand grip strength, muscle mass, and fat mass, whilst adjusting for lifestyle information (income, smoking status, diet, self-reported physical activity), blood sample derived testosterone and systemic inflammation (C-reactive protein), cardiometabolic health (cardiovascular disease, hypertension, type 2 diabetes), and depression.
In adjusted models, reduced dominant HGS was associated with lower oxygen nadir (unstandardised β [B] = 0.19, 95% confidence interval [CI] 0.08 to 0.29), greater time spent below 90% oxygen saturation (B = -0.08, 95% CI -0.14 to -0.02), and increased apnea duration (B = -0.3, 95% CI -0.23 to -0.02). By contrast, there were no associations between HGS and both AHI and REM AHI. Fat mass was consistently associated with worsening OSA indices, whereas muscle mass demonstrated no associations with any OSA index.
Our findings suggest impairments in HGS may be related to fat infiltration of muscle, hypoxemia-induced reductions in peripheral neural innervation, or even endothelial dysfunction, which is a common outcome of hypoxemia. Longitudinal data are needed to further examine these hypotheses and establish if reduced grip strength in patients with OSA is associated with long-term adverse health outcomes.
握力降低与慢性疾病患者的健康状况较差有关，但很少有研究探讨握力与阻塞性睡眠呼吸暂停（OSA）之间的关联。此外，这些研究未对肌肉量进行检测或校正。本研究的目的是确定OSA指标、握力、肌肉量和脂肪量之间的关联。
来自基于人群的男性雄激素、炎症、生活方式、环境与压力研究的613名参与者（年龄范围41 - 88岁，BMI 28.6±4.3）在家中接受了夜间多导睡眠监测、优势手和非优势手握力评估以及双能X线吸收法以确定全身肌肉量和脂肪量。线性模型确定了多导睡眠图得出的OSA指标与握力、肌肉量和脂肪量之间的横断面关联，同时校正了生活方式信息（收入、吸烟状况、饮食、自我报告的身体活动）、血液样本中的睾酮和全身炎症（C反应蛋白）、心脏代谢健康（心血管疾病、高血压、2型糖尿病）以及抑郁情况。
在校正模型中，优势手握力降低与更低的最低血氧饱和度（未标准化β[B]=0.19，95%置信区间[CI]0.08至0.29）、在血氧饱和度低于90%时花费的时间更长（B = -0.08，95% CI -0.14至 -0.02）以及呼吸暂停持续时间增加（B = -0.3，95% CI -0.23至 -0.02）相关。相比之下，握力与呼吸暂停低通气指数（AHI）和快速眼动期AHI均无关联。脂肪量始终与OSA指标恶化相关，而肌肉量与任何OSA指标均无关联。
我们的研究结果表明，握力受损可能与肌肉的脂肪浸润、低氧血症引起的外周神经支配减少或甚至内皮功能障碍有关，内皮功能障碍是低氧血症的常见后果。需要纵向数据来进一步检验这些假设，并确定OSA患者握力降低是否与长期不良健康结局相关。
