Chuang Hai-Hua, Liu Chi-Hung, Wang Chao-Yung, Lo Yu-Lun, Lee Guo-She, Chao Yi-Ping, Li Hsueh-Yu, Kuo Terry B J, Yang Cheryl C H, Shyu Liang-Yu, Lee Li-Ang
Department of Family Medicine, Chang Gung Memorial Hospital, Taipei Branch and Linkou Main Branch, Chang Gung University, Taoyuan, Taiwan.
Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei, Taiwan.
Nat Sci Sleep. 2021 Jul 24;13:1243-1255. doi: 10.2147/NSS.S311125. eCollection 2021.
Obstructive sleep apnea (OSA) and snoring have been reported to be modifiable risk factors for thick carotid intima-media thickness (CIMT) and carotid atherosclerosis, which are closely linked to cardiovascular disease.
This cross-sectional study prospectively recruited 70 participants with OSA and without a history of carotid artery disorder, who primarily sought surgical Intervention. OSA and snoring were assessed with the Epworth Sleepiness Scale, Snore Outcomes Survey, polysomnography, and snoring sound recording. The carotid arteries were evaluated with ultrasonography and divided into three types of carotid artery profiles (normal carotid artery, thick CIMT, or significant carotid atherosclerosis). Multivariate linear/logistic/categorical regressions were performed with the forward selection approaches/logistic least absolute shrinkage and selection operator, as appropriate.
Normalized snoring sound energy (301-850 Hz) was independently associated with the carotid intima-media thickness (regression coefficient [β] = 0.01, standard error [SE] = 0.004, = 0.03; = 0.067) and type of carotid profile (β = 0.40, SE = 0.09, < 0.001; = 0.156). Normalized snoring sound energy (4-300 Hz) (β = -0.10, SE = 0.04, = 0.01) and female sex (β = 1.90, SE = 0.94, = 0.04) were independently related to the presence of carotid stenosis ( = 0.159). The optimal regression model of the type of carotid artery profile included normalized snoring sound energy (301-850 Hz) (β = 0.33, SE = 0.14, = 0.03), snoring time (β = 0.26, SE = 0.13, = 0.047), female sex (β = 0.26, SE = 0.13, = 0.047), and increased age (β = 0.20, SE = 0.10, = 0.04) under the control of the Snore Outcomes Survey score, 3% oxygen desaturation index, snoring sound energy (4-1500 Hz), normalized snoring sound energy (851-1500 Hz), cigarette smoking, and hyperlipidemia ( = 0.427).
Our findings suggested that snoring sound characteristics are associated with carotid artery profiles among early OSA patients who cannot be noticed by ultrasound because organic changes of the carotid artery have not yet started. Future studies are warranted to verify the clinical significance of the results.
据报道，阻塞性睡眠呼吸暂停（OSA）和打鼾是颈动脉内膜中层厚度（CIMT）增厚和颈动脉粥样硬化的可改变风险因素，而这两者与心血管疾病密切相关。
这项横断面研究前瞻性招募了70名患有OSA且无颈动脉疾病史的参与者，他们，他们主要寻求手术干预。通过Epworth嗜睡量表、打鼾结果调查、多导睡眠图和打鼾声音记录来评估OSA和打鼾情况。用超声检查评估颈动脉，并将其分为三种类型的颈动脉轮廓（正常颈动脉、CIMT增厚或显著颈动脉粥样硬化）。根据情况，采用向前选择法/逻辑最小绝对收缩和选择算子进行多变量线性/逻辑/分类回归。
标准化打鼾声能量（301 - 850Hz）与颈动脉内膜中层厚度独立相关（回归系数[β]=0.01，标准误[SE]=0.004，P = 0.03；R² = 0.067）以及颈动脉轮廓类型（β = 0.40，SE = 0.09，P < 0.001；R² = 0.156）。标准化打鼾声能量（4 - 300Hz）（β = -0.10，SE = 0.04，P = 0.01）和女性性别（β = 1.90，SE = 0.94，P = 0.04）与颈动脉狭窄的存在独立相关（R² = 0.159）。在控制打鼾结果调查得分、3%氧饱和度下降指数、打鼾声能量（4 - 1500Hz）、标准化打鼾声能量（851 - 1500Hz）、吸烟和高脂血症的情况下，颈动脉轮廓类型的最佳回归模型包括标准化打鼾声能量（301 - 850Hz）（β = 0.33，SE = 0.14，P = 0.03）、打鼾时间（β = 0.26，SE = 0.13，P = 0.047）、女性性别（β = 0.26，SE = 0.13，P = 0.047）和年龄增加（β = 0.20，SE = 0.10，P = 0.04）（R² = 0.427）。
我们的研究结果表明，在早期OSA患者中，打鼾声音特征与颈动脉轮廓相关，这些患者因颈动脉尚未开始发生器质性改变而无法通过超声检测到。未来的研究有必要验证这些结果的临床意义。
