Emergency Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China.
National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
BMC Psychiatry. 2024 Aug 13;24(1):560. doi: 10.1186/s12888-024-05990-y.
We aimed to explore the impact of adherence to Life's Simple 7 (LS7) metrics on risk of obstructive sleep apnea (OSA), and the impact of inflammation on the association, in adults in the United States.
Data from 13,825 community-dwelling adults aged ≥ 20 years recruited in the National Health and Nutrition Examination Surveys (NHANES) 2005-2008, 2015-2018 was analyzed. The LS7 score was calculated based on the AHA definition of LS7 metrics. The diagnosis of OSA was based on self-reported symptoms of sleep disturbance using a standard questionnaire. The Multivariable Apnea Prediction (MAP) Index score was also calculated to assess the risk of OSA. Log-binominal regression and negative binomial regression were performed to estimate the associations between LS7 and OSA and MAP index, with odds ratios (ORs) and prevalence ratios (PRs) and their 95% confidence intervals (CIs) calculated. Mediation analysis was performed to estimate the mediating effects of inflammatory indicators on the associations.
A total of 4473 participants (32.4%) had OSA, and the mean MAP index was 0.39. In fully adjusted log-binominal regression models, with total score < 6 as the reference, the ORs (95% CIs) for risk of OSA were 0.90 (0.73, 1.10), 0.76 (0.65, 0.89), 0.78 (0.64, 0.95), and 0.45 (0.38, 0.54) for total score = 6, total score = 7, total score = 8, and total score > 8, respectively (P for trend < 0.001). When LS7 score was analyzed as a continuous variable, each 1-point increase in LS7 score was associated with a 15% decrease in OSA risk (P < 0.001). In negative binominal regression models, the adjusted PRs (95% CIs) for the MAP index were 0.93 (0.90, 0.97), 0.87 (0.84, 0.91), 0.80 (0.77, 0.84), and 0.55 (0.53, 0.57) for total score = 6, total score = 7, total score = 8, and total score > 8, respectively (P for trend < 0.001). For each 1-point increase in LS7 score, the risk of OSA decreased by 13% (P < 0.001). Consistent results were observed in subgroup analysis. Mediation analysis indicated that inflammatory factors, including blood cell count, neutrophil count, and C-reactive protein, positively mediated the association of LS7 with OSA, with a mediation proportion of 0.022 (P = 0.04), 0.02 (P = 0.04), and 0.02 (P = 0.02), respectively.
In a nationally representative sample of US adults, adherence to LS7 metrics was independently associated with reduced OSA risk. Inflammation plays a mediating role in the association between LS7 and OSA.
我们旨在探讨在美国成年人中，遵循生命简单 7（LS7）指标与阻塞性睡眠呼吸暂停（OSA）风险的关系，以及炎症对这种关联的影响。
分析了来自于 2005-2008 年和 2015-2018 年全国健康和营养调查（NHANES）中年龄≥20 岁的 13825 名社区居民的数据。根据美国心脏协会对 LS7 指标的定义计算 LS7 评分。OSA 的诊断基于使用标准问卷报告的睡眠障碍症状。还计算了多变量呼吸暂停预测（MAP）指数评分，以评估 OSA 的风险。采用对数二项式回归和负二项式回归来估计 LS7 与 OSA 和 MAP 指数之间的关联，计算比值比（ORs）和患病率比（PRs）及其 95%置信区间（CIs）。进行中介分析以估计炎症指标对关联的中介作用。
共有 4473 名参与者（32.4%）患有 OSA，平均 MAP 指数为 0.39。在完全调整的对数二项式回归模型中，以总分<6 作为参考，OSA 风险的 ORs（95% CIs）分别为 0.90（0.73，1.10）、0.76（0.65，0.89）、0.78（0.64，0.95）和 0.45（0.38，0.54），总分分别为 6、7、8 和>8（P<0.001）。当 LS7 评分作为连续变量进行分析时，LS7 评分每增加 1 分，OSA 风险降低 15%（P<0.001）。在负二项式回归模型中，MAP 指数的调整后 PRs（95% CIs）分别为 0.93（0.90，0.97）、0.87（0.84，0.91）、0.80（0.77，0.84）和 0.55（0.53，0.57），总分分别为 6、7、8 和>8（P<0.001）。LS7 评分每增加 1 分，OSA 风险降低 13%（P<0.001）。亚组分析也得到了一致的结果。中介分析表明，包括血细胞计数、中性粒细胞计数和 C 反应蛋白在内的炎症因子正向介导了 LS7 与 OSA 之间的关联，中介比例分别为 0.022（P=0.04）、0.02（P=0.04）和 0.02（P=0.02）。
在具有全国代表性的美国成年人样本中，遵循 LS7 指标与 OSA 风险降低独立相关。炎症在 LS7 与 OSA 之间的关联中起中介作用。
