Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON; Ottawa Hospital Research Institute, Ottawa, ON.
Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON.
Chest. 2022 Nov;162(5):1176-1187. doi: 10.1016/j.chest.2022.07.017. Epub 2022 Aug 5.
Ambient air pollution may affect the severity of untreated OSA, but it is unknown whether air pollution adversely impacts the effectiveness of positive airway pressure (PAP) therapy.
Do short-term changes in outdoor air pollution adversely impact adults with OSA using PAP therapy?
We conducted a retrospective community-based repeated-measures longitudinal study of adults with OSA who purchased a PAP device from a registered equipment provider between 2013 and 2017 (Ontario, Canada) and had data on the daily device-derived residual apnea-hypopnea index (AHI). We linked daily PAP-derived data to air pollution databases using postal codes. The primary exposures were mean nocturnal (8 pm to 8 am) residential concentrations of ozone, fine particulate matter, nitrogen dioxide, carbon monoxide, sulfur dioxide, and the Air Quality Health Index (AQHI). Potential confounders considered were demographics, season and year of exposure, initial OSA severity, other PAP parameters, and climate-related variables.
Eight thousand one hundred forty-eight adults were analyzed with a median of 89 days (interquartile range [IQR], 29-302 days) of observation during which PAP was used for ≥ 4 h. The median daily AHI was 1.2/h (IQR, 0.5-2.5/h). In mixed multivariate regression analyses, an increase in air pollution was associated with a statistically significant increase in AHI for most statistical models. The largest effect was for the AQHI: an increase in AHI while comparing highest vs lowest quartiles was 0.07/h (95% CI, 0.05-0.10/h).
We demonstrated a modest but statistically significant increase in residual respiratory events during PAP therapy associated with an increase in air pollution concentrations.
环境空气污染可能会影响未经治疗的阻塞性睡眠呼吸暂停（OSA）的严重程度，但目前尚不清楚空气污染是否会对气道正压通气（PAP）治疗的效果产生不利影响。
短期户外空气污染变化是否会对使用 PAP 治疗的 OSA 成年人产生不利影响？
我们进行了一项回顾性基于社区的重复测量纵向研究，纳入了 2013 年至 2017 年期间从注册设备供应商处购买 PAP 设备的 OSA 成年人（加拿大安大略省），并记录了每日设备衍生的残余睡眠呼吸暂停低通气指数（AHI）数据。我们使用邮政编码将每日 PAP 衍生数据与空气污染数据库联系起来。主要暴露因素是夜间（8 点至 8 点）住宅臭氧、细颗粒物、二氧化氮、一氧化碳、二氧化硫和空气质量健康指数（AQHI）的平均浓度。考虑的潜在混杂因素包括人口统计学、暴露的季节和年份、初始 OSA 严重程度、其他 PAP 参数以及与气候相关的变量。
共分析了 8148 名成年人，中位观察时间为 89 天（四分位距[IQR]，29-302 天），在此期间至少有 4 小时使用了 PAP。中位每日 AHI 为 1.2/h（IQR，0.5-2.5/h）。在混合多变量回归分析中，对于大多数统计模型，空气污染增加与 AHI 统计学上显著增加相关。最大的影响是 AQHI：在比较最高与最低四分位数时，AHI 增加了 0.07/h（95%CI，0.05-0.10/h）。
我们证明了在 PAP 治疗期间，与空气污染浓度增加相关的残余呼吸事件略有增加，但具有统计学意义。
