Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong, Hong Kong, China,
Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Neuroepidemiology. 2023;57(6):391-399. doi: 10.1159/000533843. Epub 2023 Sep 1.
Obstructive sleep apnea (OSA) is an independent risk factor for stroke. Furthermore, intracranial arterial calcification (IAC) has been validated as a marker for subclinical cerebrovascular disease. However, the relationship between OSA with IAC was less studied compared with its established association with coronary artery calcification. In this study, we aimed to investigate the association between the severity of OSA and the degree of IAC in hospitalized patients without preexisting cardiovascular disease.
This hospital-based observational study was conducted from June 1, 2017, to May 1, 2019. In total, 901 consecutive patients who underwent head computed tomography scans and portable sleep monitoring were included. On the basis of the apnea-hypopnea index (AHI), patients were divided into four OSA severity groups (normal: AHI <5/h; mild: 5≤ AHI <15/h; moderate: 15≤ AHI <30/h; severe: AHI ≥30/h). Associations of OSA with IAC scores were assessed by using multivariate logistic regression analysis.
Of the 901 patients, 484 (53.7%) were men; the mean (SD) age was 66.1 (10.0) years. The non-OSA group included 207 (23.0%) patients; mild OSA, 209 (23.2%); moderate OSA, 235 (26.1%); and severe OSA, 169 (18.8%). Mean IAC scores were higher in the severe OSA group compared with non-, mild, and moderate OSA groups (4.79 vs. 2.58; 4.79 vs. 2.94; 4.79 vs. 3.39; p < 0.001). Multivariate analysis adjusted for confounding factors revealed that only severe OSA was associated with a higher IAC score (odds ratio [OR]: 1.65; 95% confidence interval [CI]: 1.43-1.91; p < 0.001). In stratified analyses by BMI, among participants with a BMI <25 kg/m2, the positive association between AHI values and IAC scores was found in the moderate OSA group (OR: 1.23; 95% CI: 1.05, 1.43; p = 0.01) and the severe OSA group (OR: 1.96; 95% CI: 1.55, 2.48; p < 0.001). When stratified by gender, in women, the positive association was found in the moderate OSA group (adjusted OR: 1.21; 95% CI: 1.02-1.51; p = 0.016) and the severe OSA group (adjusted OR: 1.76; 95% CI: 1.36-2.25; p < 0.001). For the men group, a positive association between IAC scores and AHI was only observed in the severe OSA group.
These findings suggest that OSA, in particular severe OSA (AHI ≥30), is independently associated with higher IAC scores. Women and no-obesity individuals appeared more susceptible to adverse OSA-related subclinical cerebrovascular disease as measured by IAC scores.
阻塞性睡眠呼吸暂停（OSA）是中风的独立危险因素。此外，颅内动脉钙化（IAC）已被验证为亚临床脑血管疾病的标志物。然而，与 OSA 与冠状动脉钙化的既定关联相比，OSA 与 IAC 之间的关系研究较少。在这项研究中，我们旨在调查无潜在心血管疾病住院患者中 OSA 严重程度与 IAC 程度之间的关系。
这是一项基于医院的观察性研究，于 2017 年 6 月 1 日至 2019 年 5 月 1 日进行。共纳入 901 例接受头部计算机断层扫描和便携式睡眠监测的连续患者。根据呼吸暂停低通气指数（AHI），患者被分为 4 个 OSA 严重程度组（正常：AHI <5/h；轻度：5≤ AHI <15/h；中度：15≤ AHI <30/h；重度：AHI ≥30/h）。采用多变量 logistic 回归分析评估 OSA 与 IAC 评分的关联。
在 901 例患者中，484 例（53.7%）为男性；平均（SD）年龄为 66.1（10.0）岁。非 OSA 组包括 207 例（23.0%）患者；轻度 OSA 209 例（23.2%）；中度 OSA 235 例（26.1%）；重度 OSA 169 例（18.8%）。与非 OSA、轻度和中度 OSA 组相比，重度 OSA 组的平均 IAC 评分更高（4.79 比 2.58；4.79 比 2.94；4.79 比 3.39；p < 0.001）。多变量分析调整混杂因素后显示，只有重度 OSA 与较高的 IAC 评分相关（比值比 [OR]：1.65；95%置信区间 [CI]：1.43-1.91；p < 0.001）。在 BMI 分层分析中，在 BMI <25 kg/m2 的参与者中，中度 OSA 组（OR：1.23；95%CI：1.05，1.43；p = 0.01）和重度 OSA 组（OR：1.96；95%CI：1.55，2.48；p < 0.001）中 AHI 值与 IAC 评分之间呈正相关。按性别分层时，在女性中，中度 OSA 组（调整后的 OR：1.21；95%CI：1.02-1.51；p = 0.016）和重度 OSA 组（调整后的 OR：1.76；95%CI：1.36-2.25；p < 0.001）中也存在这种正相关关系。对于男性组，仅在重度 OSA 组中观察到 IAC 评分与 AHI 之间存在正相关关系。
这些发现表明，OSA，特别是严重 OSA（AHI ≥30），与较高的 IAC 评分独立相关。女性和非肥胖个体似乎更容易受到 IAC 评分测量的与 OSA 相关的亚临床脑血管疾病的影响。
