Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, HKSAR, China; JC School of Public Health and Primary Care, The Chinese University of Hong Kong, HKSAR, China.
Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.
Environ Pollut. 2022 Aug 1;306:119393. doi: 10.1016/j.envpol.2022.119393. Epub 2022 May 4.
Emerging evidence witnesses the association of air pollution exposure with sleep disorders or the risk of obstructive sleep apnea (OSA); however, the results are not consistent. OSA patients with or without a low arousal threshold (LAT) have different pathology and therapeutic schemes. No study has evaluated the potential diverse effects of air pollution on the phenotypes of OSA. The current study aimed to evaluate the associations of short-term and long-term exposure to air pollution with sleep-disordered measures and OSA phenotypes. This cross-sectional study consisted of 4634 participants from a sleep center in Taipei from January 2015 to April 2019. The personal exposure to ambient PM and NO was assessed by a spatial-temporal model. Overnight polysomnography was used to measure the sleep parameters. According to a developed clinical tool, we defined the low arousal threshold (LAT) and identified the OSA patients with or without LAT. We applied a generalized linear model and multinomial logistic regression model to estimate the change of sleep measures and risk of the OSA phenotypes, respectively, associated with an interquartile range (IQR) increment of personal pollution exposure after adjusting for the essential confounders. In the single-pollutant model, we observed the associations of NO with sleep-disordered measures by decreasing the total sleep time, sleep efficiency, extending the time of wake after sleep onset, and the association of NO with the increased risk of LAT OSA by around 15%. The two-pollutant model with both long-term and short-term exposures confirmed the most robust associations of long-term NO exposure with sleep measures. An IQR increment of NO averaged over the past year (6.0 ppb) decreased 3.32 min of total sleep time and 0.85% of sleep efficiency. Mitigating exposure to air pollution may improve sleep quality and reduce the risk of LAT OSA.
新出现的证据表明，空气污染暴露与睡眠障碍或阻塞性睡眠呼吸暂停（OSA）的风险有关；然而，结果并不一致。有或没有低唤醒阈值（LAT）的 OSA 患者有不同的病理和治疗方案。没有研究评估空气污染对 OSA 表型的潜在不同影响。本研究旨在评估短期和长期暴露于空气污染与睡眠障碍测量和 OSA 表型的关联。这项横断面研究包括 2015 年 1 月至 2019 年 4 月来自台北睡眠中心的 4634 名参与者。通过时空模型评估环境 PM 和 NO 的个人暴露。整夜多导睡眠图用于测量睡眠参数。根据开发的临床工具，我们定义了低唤醒阈值（LAT），并确定了有或没有 LAT 的 OSA 患者。我们应用广义线性模型和多项逻辑回归模型，分别估计与个人污染暴露的 IQR 增量相关的睡眠测量值的变化和 OSA 表型的风险，在调整了基本混杂因素后。在单污染物模型中，我们观察到随着总睡眠时间、睡眠效率的降低，NO 与睡眠障碍指标有关，NO 与 LAT OSA 风险增加有关，风险增加了约 15%。同时考虑长期和短期暴露的双污染物模型证实了长期 NO 暴露与睡眠指标的最密切关联。过去一年（6.0ppb）NO 的平均 IQR 增量减少了 3.32 分钟的总睡眠时间和 0.85%的睡眠效率。减轻空气污染暴露可能会改善睡眠质量并降低 LAT OSA 的风险。
