Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Eur Respir J. 2022 Feb 3;59(2). doi: 10.1183/13993003.00606-2021. Print 2022 Feb.
Reduced physical activity and increased sedentary behaviour may independently contribute to the development of obstructive sleep apnoea (OSA) through increased adiposity, inflammation, insulin resistance and body fluid retention. However, epidemiological evidence remains sparse and is primarily limited to cross-sectional studies.
We prospectively followed 50 332 women from the Nurses' Health Study (2002-2012), 68 265 women from the Nurses' Health Study II (1995-2013) and 19 320 men from the Health Professionals Follow-up Study (1996-2012). Recreational physical activity (quantified by metabolic equivalent of task (MET)-h per week) and sitting time spent watching TV and at work/away from home were assessed by questionnaires every 2-4 years. Physician-diagnosed OSA was identified by validated self-report. Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals for OSA incidence associated with physical activity and sedentary behaviour.
During 2 004 663 person-years of follow-up, we documented 8733 incident OSA cases. After adjusting for potential confounders, the pooled HR for OSA comparing participants with ≥36.0 <6.0 MET-h per week of physical activity was 0.46 (95% CI 0.43-0.50; p<0.001). Compared with participants spending <4.0 h per week sitting watching TV, the multivariable-adjusted HR was 1.78 (95% CI 1.60-1.98) for participants spending ≥28.0 h per week (p<0.001). The comparable HR was 1.49 (95% CI 1.38-1.62) for sitting hours at work/away from home (p<0.001). With additional adjustment for several metabolic factors, including body mass index and waist circumference, the associations with physical activity and sitting hours at work/away from home were attenuated but remained significant (p<0.001), whereas the association with sitting hours watching TV was no longer statistically significant (p=0.18).
Higher levels of physical activity and fewer sedentary hours were associated with lower OSA incidence. The potential mediating role of metabolic factors in the association between sedentary behaviour and OSA incidence may depend on the type of sedentary behaviour. Our results suggest that promoting an active lifestyle may reduce OSA incidence.
体力活动减少和久坐行为增加可能通过增加肥胖、炎症、胰岛素抵抗和体液潴留，独立导致阻塞性睡眠呼吸暂停（OSA）的发生。然而，流行病学证据仍然很少，主要限于横断面研究。
我们前瞻性地随访了来自护士健康研究（2002-2012 年）的 50332 名女性、来自护士健康研究 II（1995-2013 年）的 68265 名女性和来自健康专业人员随访研究（1996-2012 年）的 19320 名男性。每周通过代谢当量任务（MET）小时数来评估娱乐性体力活动（量化）和看电视及工作/离家时的久坐时间，每 2-4 年通过问卷调查一次。医生诊断的 OSA 通过验证性自我报告确定。Cox 模型用于估计与体力活动和久坐行为相关的 OSA 发病率的风险比（HR）和 95%置信区间。
在 2004663 人年的随访期间，我们记录了 8733 例 OSA 发病病例。在调整了潜在混杂因素后，与每周进行≥36.0 <6.0 MET-h 体力活动的参与者相比，OSA 发病率的合并 HR 为 0.46（95%CI 0.43-0.50；p<0.001）。与每周看电视时间<4.0 小时的参与者相比，每周看电视时间≥28.0 小时的参与者校正多变量后的 HR 为 1.78（95%CI 1.60-1.98）（p<0.001）。对于工作/离家时的久坐时间，可比 HR 为 1.49（95%CI 1.38-1.62）（p<0.001）。当进一步调整包括体重指数和腰围在内的几种代谢因素时，体力活动和工作/离家时久坐时间的关联减弱，但仍具有统计学意义（p<0.001），而与看电视时间的关联不再具有统计学意义（p=0.18）。
较高水平的体力活动和较少的久坐时间与较低的 OSA 发病率相关。代谢因素在久坐行为与 OSA 发病率之间的关联中的潜在中介作用可能取决于久坐行为的类型。我们的研究结果表明，促进积极的生活方式可能会降低 OSA 的发病率。
