非糖尿病睡眠诊所队列中颈动脉和股动脉内膜中层厚度的预测因素。

Predictors for carotid and femoral artery intima-media thickness in a non-diabetic sleep clinic cohort.

机构信息

Ludwig Engel Centre for Respiratory Research, The Westmead Institute for Medical Research, Westmead, Sydney, New South Wales, Australia.

Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Sydney, New South Wales, Australia.

出版信息

PLoS One. 2021 Jun 4;16(6):e0252569. doi: 10.1371/journal.pone.0252569. eCollection 2021.

DOI:10.1371/journal.pone.0252569

PMID:34086802

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8177540/

Abstract

INTRODUCTION

The impact of sleep disordered breathing (SDB) on arterial intima-media thickness (IMT), a surrogate measure for cardiovascular disease, remains uncertain, in part because of the potential for non-SDB vascular risk factor interactions. In the present study, we determined predictors for common carotid (CCA) and femoral (CFA) artery IMT in an adult, sleep clinic cohort where non-SDB vascular risk factors (particularly diabetes) were eliminated or controlled.

METHODS

We recruited 296 participants for polysomnography (standard SDB severity metrics) and CCA/CFA ultrasound examinations, followed by a 12 month vascular risk factor minimisation (RFM) and continuous positive pressure (CPAP) intervention for participants with a range of SDB severity (RFM Sub-Group, n = 157; apnea hyponea index [AHI]: 14.7 (7.2-33.2), median [IQR]). Univariable and multivariable linear regression models determined independent predictors for IMT. Linear mixed effects modelling determined independent predictors for IMT change across the intervention study. P<0.05 was considered significant.

RESULTS

Age, systolic blood pressure and waist:hip ratio were identified as non-SDB predictive factors for CCA IMT and age, weight and total cholesterol:HDL ratio for CFA IMT. No SDB severity metric emerged as an independent predictor for either CCA or CFA IMT, except in the RFM Sub-Group, where a 2-fold increase in AHI predicted a 2.4% increase in CFA IMT. Across the intervention study, CCA IMT decreased in those who lost weight, but there was no CPAP use interaction. CFA IMT, however, decreased by 12.9% (95%CI 6.8, 18.7%, p = 0.001) in those participants who both lost weight and used CPAP > = 4hours/night.

CONCLUSION

We conclude that SDB severity has little impact on CCA IMT values when non-SDB vascular risk factors are minimised or not present. This is the first study, however, to suggest a potential linkage between SDB severity and CFA IMT values.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry, ACTRN12611000250932 and ACTRN12620000694910.

摘要

简介

睡眠呼吸障碍（SDB）对动脉内膜中层厚度（IMT）的影响，作为心血管疾病的替代指标，尚不确定，部分原因是存在非 SDB 血管危险因素的相互作用。在本研究中，我们在一个成年人睡眠诊所队列中确定了颈总动脉（CCA）和股总动脉（CFA）IMT 的预测因素，其中排除或控制了非 SDB 血管危险因素（特别是糖尿病）。

方法

我们招募了 296 名参与者进行多导睡眠图检查（标准 SDB 严重程度指标）和 CCA/CFA 超声检查，随后对 SDB 严重程度范围的参与者进行为期 12 个月的血管危险因素最小化（RFM）和持续气道正压通气（CPAP）干预（RFM 亚组，n=157；呼吸暂停低通气指数 [AHI]：14.7（7.2-33.2），中位数[IQR]）。单变量和多变量线性回归模型确定了 IMT 的独立预测因素。线性混合效应模型确定了干预研究中 IMT 变化的独立预测因素。P<0.05 被认为具有统计学意义。

结果

年龄、收缩压和腰臀比是 CCA IMT 的非 SDB 预测因素，年龄、体重和总胆固醇/高密度脂蛋白比值是 CFA IMT 的预测因素。除了 RFM 亚组中 AHI 增加 2 倍预测 CFA IMT 增加 2.4%外，没有 SDB 严重程度指标成为 CCA 或 CFA IMT 的独立预测因素。在干预研究中，体重减轻的患者 CCA IMT 降低，但 CPAP 使用没有交互作用。然而，在既减轻体重又使用 CPAP > = 4 小时/夜的患者中，CFA IMT 降低了 12.9%（95%CI 6.8，18.7%，p=0.001）。