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[阻塞性睡眠呼吸暂停与代谢综合征:基于大型临床数据库的关联研究]

[Obstructive sleep apnea and metabolic syndrome: an association study based on a large sample clinical database].

作者信息

Guo W B, Liu Y P, Xu H H, Meng L L, Zhu H M, Wu H M, Guan J, Yi H L, Yin S K

机构信息

Department of Otorhinolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital,Shanghai 200233, China Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai 200233, China.

出版信息

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Dec 7;56(12):1263-1269. doi: 10.3760/cma.j.cn115330-20210531-00314.

DOI:10.3760/cma.j.cn115330-20210531-00314
PMID:34963213
Abstract

To investigate the prevalence and associated risk factors of metabolic syndrome (MS) in patients with obstructive sleep apnea (OSA). From July 2007 to June 2017, a total of 8 155 adult subjects, including 6 484 males and 1 671 females, aged 18-90 (43.13±12.28), body mass index 14.61~59.56 (25.59±3.98) kg/m,who were admitted to the Department of Otorhinolaryngology head and Neck surgery of The Sixth People's Hospital affiliated to Shanghai Jiao Tong University, were retrospectively analyzed. All patients underwent polysomnography and biochemical tests. Subjects were divided into four groups (non-OSA, mild OSA, moderate OSA, and severe OSA) according to OSA severity. The prevalence of MS was expressed as percentage, and the correlation between OSA and MS and its characteristic pathophysiological indicators was evaluated by logistic regression model after adjusting for factors such as gender, age, BMI, neck circumference, hip circumference, smoking and alcohol consumption, and was expressed by odds ratio (OR). SPSS 25.0 software was used for statistical analysis. The overall prevalence of MS was 43.6%, and that of non-/mild/moderate/severe OSA group was 18.6%, 30.4%, 43.8%, 57.1%.Logistic regression showed that patients with mild/moderate/severe OSA had an increased risk of MS compared with non-OSA patients, with adjusted OR values and confidence intervals of 1.27 (1.05-1.54), 1.84 (1.53-2.22), and 2.08 (1.76-2.46), respectively (<0.01).In addition, indicators of OSA anoxic burden [oxygen drop index(T=7.1), minimum blood oxygen(T=56.3), blood oxygen saturation below 90% cumulative time ratio (T=10.6) ]were closely associated with MS disease(<0.01), but sleep fragmentation index (arousals index) was not significantly associated with MS disease. The risk of MS gradually increases with the severity of OSA, and the indicators reflecting OSA hypoxia burden are closely related to MS disease.

摘要

探讨阻塞性睡眠呼吸暂停(OSA)患者代谢综合征(MS)的患病率及相关危险因素。回顾性分析2007年7月至2017年6月期间,上海交通大学附属第六人民医院耳鼻咽喉头颈外科收治的8155例成年患者,年龄18 - 90岁(43.13±12.28),体重指数14.61~59.56(25.59±3.98)kg/m²,其中男性6484例,女性1671例。所有患者均接受多导睡眠监测和生化检查。根据OSA严重程度将受试者分为四组(非OSA、轻度OSA、中度OSA和重度OSA)。MS患病率以百分比表示,在调整性别、年龄、BMI、颈围、臀围、吸烟和饮酒等因素后,通过逻辑回归模型评估OSA与MS及其特征性病理生理指标之间的相关性,以比值比(OR)表示。采用SPSS 25.0软件进行统计分析。MS的总体患病率为43.6%,非/轻度/中度/重度OSA组分别为18.6%、30.4%、43.8%、57.1%。逻辑回归显示,与非OSA患者相比,轻度/中度/重度OSA患者患MS的风险增加,调整后的OR值及置信区间分别为1.27(1.05 - 1.54)、1.84(1.53 - 2.22)和2.08(1.76 - 2.46)(P<0.01)。此外,OSA缺氧负荷指标[氧降指数(T = 7.1))、最低血氧(T = 56.3)、血氧饱和度低于90%的累计时间比(T = 10.6)]与MS疾病密切相关(P<0.01),但睡眠片段化指数(觉醒指数)与MS疾病无显著相关性。MS的风险随着OSA严重程度的增加而逐渐升高,反映OSA缺氧负荷的指标与MS疾病密切相关。

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