Department of Neurosciences and Shiley-Marcos Alzheimer's Disease Research Center, University of California San Diego School of Medicine, San Diego, California, United States of America.
Department of Healthcare Sciences and Institute of Gerontology, Wayne State University, Detroit, Michigan, United States of America.
PLoS One. 2022 Apr 4;17(4):e0265151. doi: 10.1371/journal.pone.0265151. eCollection 2022.
Identifying Obstructive Sleep Apnea (OSA) phenotypes among middle-aged and older Hispanics/Latinos can facilitate personalized care, better inform treatment decisions, and could lead to improved clinical outcomes.
We focused on middle-aged and older adults (ages ≥45-74 years at baseline) with an apnea-hypopnea index (AHI) ≥5 from the HCHS/SOL (2008-2011) (unweighted n = 3,545). We used latent class analyses (LCA) to identify empirical and clinically meaningful OSA phenotypes. Sleep variables included AHI, percent sleep time SpO2<90%, Epworth Sleepiness Scale (ESS), Women's Health Initiative Insomnia Rating Scale (WHIIRS) score, self-reported average sleep duration, restless legs symptoms, napping frequency, and self-reported sleep quality. We used survey logistic and Poisson regression to test the associations between our OSA phenotypes and prevalent and incident cardiovascular measures (cardiovascular disease, heart failure, Stroke/TIA, hypertension, diabetes, and the Framingham Cardiovascular Risk Score).
Average AHI, ESS, WHIIRS, and sleep duration were 18.1±19.5, 6.3±6.1, 7.4±6.6, and 7.8±1.7 hours, respectively, and 2.9% had zero percent time SpO2 <90%. We identified a three-class solution that clustered individuals into (1) insomnia OSA (44.3%), (2) asymptomatic mild OSA, (36.2%) and (3) symptomatic OSA (19.5%). Elevated WHIIRS and AHI scores primarily drove classification into groups one and three, respectively. In covariate adjusted models, OSA phenotypes were differentially associated with prevalence (baseline and seven years later) and incidence of cardiovascular measures.
OSA subtypes in diverse U.S. Hispanic/Latino adults have different cardiovascular complications. More targeted research, that takes these variations into account, could help ameliorate Hispanic/Latino sleep and cardiovascular health disparities.
在中年和老年西班牙裔/拉丁裔人群中确定阻塞性睡眠呼吸暂停（OSA）表型可以促进个性化护理，更好地为治疗决策提供信息，并可能改善临床结果。
我们关注的是来自 HCHS/SOL（2008-2011 年）的中年和老年人（基线时年龄≥45-74 岁），其呼吸暂停低通气指数（AHI）≥5（未加权 n=3545）。我们使用潜在类别分析（LCA）来确定经验性和临床有意义的 OSA 表型。睡眠变量包括 AHI、睡眠时 SpO2<90%的百分比、Epworth 睡眠量表（ESS）、妇女健康倡议失眠评定量表（WHIIRS）评分、自我报告的平均睡眠时间、不宁腿症状、小睡频率和自我报告的睡眠质量。我们使用调查逻辑回归和泊松回归来检验我们的 OSA 表型与心血管疾病的现患和新发测量指标（心血管疾病、心力衰竭、中风/TIA、高血压、糖尿病和弗雷明汉心血管风险评分）之间的关联。
平均 AHI、ESS、WHIIRS 和睡眠时间分别为 18.1±19.5、6.3±6.1、7.4±6.6 和 7.8±1.7 小时，2.9%的人睡眠时 SpO2<90%的时间为零。我们确定了一个三分类解决方案，将个体聚类为（1）失眠 OSA（44.3%）、（2）无症状轻度 OSA（36.2%）和（3）症状性 OSA（19.5%）。升高的 WHIIRS 和 AHI 评分主要分别导致组 1 和 3 的分类。在调整协变量的模型中，OSA 表型与心血管疾病测量指标的现患率（基线和七年后）和发生率存在差异。
不同美国西班牙裔/拉丁裔成年人的 OSA 亚型具有不同的心血管并发症。更有针对性的研究，考虑到这些差异，可能有助于改善西班牙裔/拉丁裔的睡眠和心血管健康差距。
