Wang Longlong, Ou Qiong, Shan Guangliang, Lao Miaochan, Pei Guo, Xu Yanxia, Huang Jinhuan, Tan Jiaoying, Chen Weiping, Lu Bing
The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China.
Sleep Center, Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, People's Republic of China.
Nat Sci Sleep. 2022 Aug 11;14:1397-1406. doi: 10.2147/NSS.S370471. eCollection 2022.
Non-sleepy sleep-disordered breathing (SDB) is increasingly recognized as an important clinical subtype. The association between non-sleepy SDB and cardiovascular disease (CVD) is not well understood. Our objectives were to investigate the relationship between non-sleepy SDB and CVD and determine which nocturnal hypoxia parameter most strongly reflects this association in a large community population.
Cross-sectional data from 3626 randomly-selected Chinese community-dwelling participants who underwent overnight type IV sleep monitoring were analyzed. Parameters of nocturnal hypoxemia were extracted from sleep monitoring devices, including mean nocturnal oxygen saturation, lowest oxygen saturation, oxygen desaturation index (ODI), and time with oxygen saturation <90%. An ODI ≥7.0 events/h was considered to signify SDB. An Epworth Sleepiness Scale score of 10 or less indicated no sleepiness.
The SDB rate was 30.7% (1114/3626), of which 96.5% (1075/1114) were considered the non-sleepy SDB subtype. ODI, typical nocturnal intermittent hypoxia indicator for SDB, was independently related to CVD, regardless of whether excessive daytime sleepiness was present. After adjusting for confounders, ODI most strongly reflected the association between non-sleepy SDB and CVD (OR:1.023; 95% CI:1.003-1.043). We observed a nonlinear association between ODI and the prevalence of CVD, where the likelihood of CVD increased with ODI≥10 events/h and a markedly increasing trend was observed with ODI ≥20 events/h (reference ODI = 7.0 events/h). Metabolic parameters, Pittsburgh Sleep Quality Index, and inflammatory marker did not mediate the association between ODI and CVD in the non-sleepy SDB subtype.
In the Chinese community-dwelling population, non-sleepy SDB was highly prevalent. ODI, an easily extracted indicator from a type IV sleep monitor, most strongly reflected the association between non-sleepy SDB and CVD.
非嗜睡性睡眠呼吸障碍（SDB）日益被视为一种重要的临床亚型。非嗜睡性SDB与心血管疾病（CVD）之间的关联尚未得到充分理解。我们的目标是研究非嗜睡性SDB与CVD之间的关系，并确定在一大群社区人群中，哪个夜间低氧参数最能强烈反映这种关联。
分析了3626名随机选择的中国社区居民参与者的横断面数据，这些参与者接受了夜间IV型睡眠监测。从睡眠监测设备中提取夜间低氧血症参数，包括夜间平均血氧饱和度、最低血氧饱和度、氧减饱和指数（ODI）以及血氧饱和度<90%的时间。ODI≥7.0次/小时被认为表示存在SDB。Epworth嗜睡量表得分10分及以下表示无嗜睡。
SDB发生率为30.7%（1114/3626），其中96.5%（1075/1114）被认为是非嗜睡性SDB亚型。ODI是SDB典型的夜间间歇性低氧指标，无论白天是否存在过度嗜睡，它都与CVD独立相关。在调整混杂因素后，ODI最能强烈反映非嗜睡性SDB与CVD之间的关联（OR：1.023；95%CI：1.003 - 1.043）。我们观察到ODI与CVD患病率之间存在非线性关联，其中当ODI≥10次/小时时CVD发生的可能性增加，而当ODI≥20次/小时时观察到明显的上升趋势（参考ODI = 7.0次/小时）。代谢参数、匹兹堡睡眠质量指数和炎症标志物在非嗜睡性SDB亚型中并未介导ODI与CVD之间的关联。
在中国社区居民人群中，非嗜睡性SDB非常普遍。ODI是一种易于从IV型睡眠监测仪中提取的指标，最能强烈反映非嗜睡性SDB与CVD之间的关联。
