未经治疗的阻塞性睡眠呼吸暂停患者中的尼古丁、酒精和咖啡因使用情况。
Nicotine, alcohol, and caffeine use among individuals with untreated obstructive sleep apnea.
机构信息
Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, 300 Cedar Street, TAC-455E South, New Haven, CT, 06520, USA.
Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA.
出版信息
Sleep Breath. 2023 Dec;27(6):2479-2490. doi: 10.1007/s11325-023-02830-3. Epub 2023 Apr 14.
BACKGROUND
Psychoactive substance use (i.e., nicotine, alcohol, and caffeine) has substantial effects on sleep architecture in healthy individuals, but their effects in those with obstructive sleep apnea (OSA) have not been well described. We aimed to describe the association between psychoactive substance use and sleep characteristics and daytime symptoms in individuals with untreated OSA.
METHODS
We performed a secondary, cross-sectional analysis of The Apnea Positive Pressure Long-term Efficacy Study (APPLES). Exposures included current smoking, alcohol and caffeine use in individuals with untreated OSA. Outcome domains included subjective and objective sleep characteristics, daytime symptoms, and comorbid conditions. Linear or logistic regression assessed the association between substance use and each domain (e.g., self-reported sleep duration, total polysomnographic sleep time, sleepiness, and anxiety).
RESULTS
Of the 919 individuals with untreated OSA, 116 (12.6%) were current cigarette smokers, 585 (63.7%) were moderate or heavy alcohol users, and 769 (83.7%) were moderate or heavy caffeine users. Participants were on average 52.2±11.9 years old, 65.2% were male with a median BMI of 30.6 (IQR: 27.2, 35.9, kg/m). Current smokers exhibited lower sleep duration (0.3 h), longer sleep latency (5 min) compared with non-smokers (all p-values < 0.05). People with heavy or moderate alcohol use exhibited more REM sleep (2.5 and 5% of total sleep time respectively), as did those with moderate caffeine use (2%, p-values < 0.05). The combined smoker plus caffeine group exhibited shorter sleep duration (0.4 h, p-value < 0.05) and higher risk for chronic pain [Odds Ratio (95%CI) = 4.83 (1.57, 14.9) compared with non-users.
CONCLUSIONS
Psychoactive substance use is associated with sleep characteristics and clinically relevant correlates in people with untreated OSA. Further investigation into the effects that various substances have on this population may present opportunities to understand disease mechanisms more fully and increase the effectiveness of treatment in OSA.
背景
在健康个体中，精神活性物质的使用（即尼古丁、酒精和咖啡因）对睡眠结构有显著影响，但在阻塞性睡眠呼吸暂停（OSA）患者中的影响尚未得到很好的描述。我们旨在描述未经治疗的 OSA 患者中精神活性物质使用与睡眠特征和白天症状之间的关系。
方法
我们对《Apnea Positive Pressure Long-term Efficacy Study (APPLES)》进行了二次、横断面分析。暴露因素包括未经治疗的 OSA 患者的当前吸烟、酒精和咖啡因使用情况。研究结果包括主观和客观睡眠特征、白天症状和合并症。线性或逻辑回归评估了物质使用与每个领域（例如，自我报告的睡眠时间、总多导睡眠图睡眠时间、嗜睡和焦虑）之间的关联。
结果
在 919 名未经治疗的 OSA 患者中，116 名（12.6%）是当前吸烟者，585 名（63.7%）是中度或重度酒精使用者，769 名（83.7%）是中度或重度咖啡因使用者。参与者平均年龄为 52.2±11.9 岁，65.2%为男性，平均 BMI 为 30.6（IQR：27.2，35.9，kg/m）。与不吸烟者相比，当前吸烟者的睡眠时间更短（0.3 小时），睡眠潜伏期更长（5 分钟）（所有 p 值均<0.05）。重度或中度酒精使用者的 REM 睡眠时间更长（分别为 2.5%和 5%的总睡眠时间），中度咖啡因使用者也是如此（2%，p 值均<0.05）。联合吸烟者和咖啡因使用者的睡眠时间更短（0.4 小时，p 值<0.05），并且更易出现慢性疼痛[与非使用者相比，比值比（95%CI）为 4.83（1.57，14.9）]。
结论
在未经治疗的 OSA 患者中，精神活性物质的使用与睡眠特征和临床相关的相关因素有关。进一步研究各种物质对这一人群的影响可能有助于更全面地了解疾病机制，并提高 OSA 的治疗效果。
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