Zhang Qingli, Wang Hong, Zhu Xinlei, Li Anni, Liu Cong, Guo Yutao, Kan Haidong, Chen Renjie
School of Public Health, Shanghai Institute of Infectious Disease and Biosecurity, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China.
Ministry of Education - Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
Innovation (Camb). 2023 Oct 20;4(6):100528. doi: 10.1016/j.xinn.2023.100528. eCollection 2023 Nov 13.
Obstructive sleep apnea (OSA) can lead to sleep deprivation, accidents, and cardiovascular diseases. However, research on the short-term effects of air pollutants on OSA severity is limited and inconsistent. We conducted a novel case time series analysis using a nationwide dataset among Huawei smart device users to assess the association between air pollution and OSA severity in a population at moderate-to-severe risk of OSA. Fixed-effects regression models were used to assess the associations between air pollution and the risk of OSA exacerbation, apnea-hypopnea index (AHI), and oxygen saturation. A total of 51,842 participants who were at moderate-to-severe risk of OSA (mean age [SD]: 45.4 [11.0], 95.5% male) were included, with 6,232,056 person-days of monitoring. The associations of fine particulate matter, nitrogen dioxide, carbon monoxide, and sulfur dioxide with OSA severity could occur during the sleep period, and last for 2 days. An increase of 1 interquartile range in the moving average concentrations of air pollution during the sleep period and the 2 previous days was associated with a 1.14%-4.31% increase in the risk of OSA exacerbation, an increase in AHI by 0.05-0.17 events/h, and a decrease in oxygen saturation (%) by 0.003-0.014. The exposure-response curves were almost linear. The associations between air pollutants and OSA were consistently stronger in participants aged 45 years or older. By virtue of the smart device-based technology, this large-scale, nationwide, longitudinal study provides compelling evidence that short-term exposure to air pollution may worsen sleep apnea. Our findings highlight the significance of ongoing efforts to improve air quality in mitigating OSA severity and the relevant disease burden in an aging era.
阻塞性睡眠呼吸暂停（OSA）可导致睡眠剥夺、事故和心血管疾病。然而，关于空气污染物对OSA严重程度的短期影响的研究有限且结果不一致。我们利用华为智能设备用户的全国性数据集进行了一项新颖的病例时间序列分析，以评估空气污染与处于中重度OSA风险人群的OSA严重程度之间的关联。使用固定效应回归模型来评估空气污染与OSA加重风险、呼吸暂停低通气指数（AHI）和血氧饱和度之间的关联。共纳入了51842名处于中重度OSA风险的参与者（平均年龄[标准差]：45.4[11.0]，95.5%为男性），监测时长为6232056人日。细颗粒物、二氧化氮、一氧化碳和二氧化硫与OSA严重程度的关联可能发生在睡眠期间，并持续2天。睡眠期间及前2天空气污染移动平均浓度每增加1个四分位间距，与OSA加重风险增加1.14%-4.31%、AHI每小时增加0.05-0.17次事件以及血氧饱和度（%）降低0.003-0.014相关。暴露-反应曲线几乎呈线性。在45岁及以上的参与者中，空气污染物与OSA之间的关联始终更强。借助基于智能设备的技术，这项大规模、全国性的纵向研究提供了有力证据，表明短期接触空气污染可能会使睡眠呼吸暂停恶化。我们的研究结果凸显了在老龄化时代持续努力改善空气质量以减轻OSA严重程度和相关疾病负担的重要性。
