Zhou Yan, Tan Xiqing, Lu Junjuan, Liu Chun
Department of Pulmonary and Critical Care Medicine, Third Xiangya Hospital, Central South University, No.138 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, People's Republic of China.
Sleep Breath. 2022 Dec;26(4):1729-1737. doi: 10.1007/s11325-022-02564-8. Epub 2022 Jan 10.
This study aimed to explore the role of hypoxia in the relationship between obstructive sleep apnea (OSA) and cardiovascular disease (CVD) death risk based on data from the Sleep Heart Health Study (SHHS).
Multivariate logistic regression analysis was used to analyze the association between OSA, hypoxia, and CVD death risk. Causal mediation analysis was performed to assess the role of hypoxia. The severity of OSA was evaluated by the apnea-hypopnea index (AHI), and the hypoxia was quantified by the percentage of sleep time with less than 90% oxygen saturation (PCTST90).
Of these 5,145 participants, 989 had no OSA, 2,110 had mild OSA, and 2,046 had moderate-to-severe OSA. After adjusting all confounders, mild OSA [odds ratio (OR): 1.800; 95% confidence interval (CI), 1.192-2.802], moderate-to-severe OSA (OR: 1.745; 95%CI, 1.148-2.758), 0 < PCTST90 < 1 (OR: 1.668; 95%CI, 1.184-2.385), and PCTST90 ≥ 1 (OR: 1.649; 95%CI, 1.148-2.400) were associated with an increased death risk of CVD. Furthermore, participants with mild OSA (OR: 3.742; 95%CI, 3.183-4.398) and moderate-to-severe OSA (OR: 19.671; 95%CI, 16.303-23.734) had a higher risk of hypoxia than those without OSA. Causal mediation analysis indicated that the average direct effect (ADM) of moderate-to-severe OSA and average causal mediation effect (ACME) of hypoxia on CVD death risk were 0.024 (95%CI, 0.004-0.040) and 0.013 (95%CI, 0.005-0.020), respectively, and the average mediating effect ratio was 33.94%.
Hypoxia played a mediating role in the increased death risk of CVD caused by OSA, and the mediating effect of hypoxia did not account for a large proportion.
本研究旨在基于睡眠心脏健康研究（SHHS）的数据，探讨缺氧在阻塞性睡眠呼吸暂停（OSA）与心血管疾病（CVD）死亡风险关系中的作用。
采用多因素逻辑回归分析来分析OSA、缺氧与CVD死亡风险之间的关联。进行因果中介分析以评估缺氧的作用。OSA的严重程度通过呼吸暂停低通气指数（AHI）进行评估，缺氧通过氧饱和度低于90%的睡眠时间百分比（PCTST90）进行量化。
在这5145名参与者中，989人无OSA，2110人有轻度OSA，2046人有中度至重度OSA。在调整所有混杂因素后，轻度OSA[比值比（OR）：1.800；95%置信区间（CI），1.192 - 2.802]、中度至重度OSA（OR：1.745；95%CI，1.148 - 2.758）、0 < PCTST90 < 1（OR：1.668；95%CI，1.184 - 2.385）和PCTST90≥1（OR：1.649；95%CI，1.148 - 2.400）与CVD死亡风险增加相关。此外，轻度OSA（OR：3.742；95%CI，3.183 - 4.398）和中度至重度OSA（OR：19.671；95%CI，16.303 - 23.734）的参与者比无OSA的参与者有更高的缺氧风险。因果中介分析表明，中度至重度OSA对CVD死亡风险的平均直接效应（ADM）和缺氧的平均因果中介效应（ACME）分别为0.024（95%CI，0.004 - 0.040）和0.013（95%CI，0.005 - 0.020），平均中介效应比为33.94%。
缺氧在OSA导致的CVD死亡风险增加中起中介作用，且缺氧的中介作用占比不大。
