Su X, Han J, Gao Y, He Z, Zhao Z, Lin J, Guo J, Chen K, Gao Y, Liu L
Department of Pulmonary and Critical Care Medicine of the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China.
Medical College, Yan'an University, Yan'an 716000, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2021 Nov 20;41(11):1592-1599. doi: 10.12122/j.issn.1673-4254.2021.11.01.
To investigate the relationship between obstructive sleep apnea (OSA) and components of metabolic syndrome (MetS) in the elderly and the implications for long-term risk for major adverse cardiovascular events (MACE).
This multicenter prospective cohort study was conducted among 1157 consecutive patients with OSA [defined as an apnea-hypopnea index (AHI) ≥5 times/h recorded by overnight polysomnography] aged ≥60 years enrolled from January, 2015 to October, 2017. All the patients did not have a history of MACE at baseline and had complete documentations of MetS indicators. The baseline demographic data, clinical characteristics, biochemical markers, and sleep parameters were collected from all the patients, who were divided into 4 groups according to the quartile level of AHI and followed up for a median of 42 months for MACE and its component events (cardiovascular death, myocardial infarction, and hospitalization for unstable angina or heart failure). Multivariate linear regression and Cox proportional risk regression models were used to analyze the correlation of MetS components with major objective predictors of OSA, AHI and LSpO and the long- term risk of MACE.
AHI and LSpO quartiles group showed a positive dose-response relationship with MetS components [fasting blood glucose, waist circumference, systolic blood pressure, and triglycerides] and a negative dose-response relationship with high-density lipoprotein level. MACE occurred in 119 (10.3%) patients with OSA during the follow-up. Multivariate Cox regression analysis showed that a high triglycerides, a high systolic blood pressure, and an increased waist circumference were independent risk factors for MACE and its component events ( < 0.05 or 0.01); a high HDL was a protective factor against MACE and myocardial infarction ( < 0.05 or 0.01) independent of the AHI. MetS components independent of LSpO showed no significant correlations with the risk of MACE or its component events.
The major diagnostic indexes AHI and LSPO in elderly patients with OSA have a dose-response relationship with MetS components, and the interaction between the components of MetS and AHI can increase the risk of MACE and its component events.
探讨老年阻塞性睡眠呼吸暂停（OSA）与代谢综合征（MetS）各组分之间的关系及其对主要不良心血管事件（MACE）长期风险的影响。
本多中心前瞻性队列研究纳入了2015年1月至2017年10月连续入选的1157例年龄≥60岁的OSA患者[定义为夜间多导睡眠图记录的呼吸暂停低通气指数（AHI）≥5次/小时]。所有患者基线时均无MACE病史，且有完整的MetS指标记录。收集所有患者的基线人口统计学数据、临床特征、生化指标和睡眠参数，根据AHI四分位数水平将患者分为4组，对MACE及其组成事件（心血管死亡、心肌梗死以及因不稳定型心绞痛或心力衰竭住院）进行了中位时间为42个月的随访。采用多变量线性回归和Cox比例风险回归模型分析MetS各组分与OSA主要客观预测指标AHI和最低血氧饱和度（LSpO）的相关性以及MACE的长期风险。
AHI和LSpO四分位数组与MetS组分[空腹血糖、腰围、收缩压和甘油三酯]呈正剂量反应关系，与高密度脂蛋白水平呈负剂量反应关系。随访期间，119例（10.3%）OSA患者发生了MACE。多变量Cox回归分析显示，高甘油三酯、高收缩压和腰围增加是MACE及其组成事件的独立危险因素（P<0.05或0.01）；高HDL是独立于AHI的预防MACE和心肌梗死的保护因素（P<0.05或0.01）。独立于LSpO的MetS组分与MACE及其组成事件的风险无显著相关性。
老年OSA患者的主要诊断指标AHI和LSPO与MetS组分呈剂量反应关系，MetS各组分与AHI之间的相互作用可增加MACE及其组成事件的风险。
