Yan Zhaoqi, Xu Yifeng, Li Keke, Liu Liangji
Jiangxi University of Traditional Chinese Medicine, Clinical Medical College, Nanchang, Jiangxi, China.
Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Department of Respiratory and Critical Care Medicine, Nanchang, Jiangxi, China.
Heliyon. 2024 Jun 6;10(12):e32514. doi: 10.1016/j.heliyon.2024.e32514. eCollection 2024 Jun 30.
The emergence of obstructive sleep apnea (OSA) is marked by a growing trend towards younger individuals, while its developmental trajectory remains shrouded in uncertainty, accompanied by intricate prognostic implications. While frailty and sleep problems often coexist, the relationship between them remains unclear. Hence, this study aims to utilize the National Health and Nutrition Examination Survey (NHANES) database from 2005 to 2008 to analyze and explore the relationship between the level of frailty index (FI) and the risk of OSA incidence and survival outcomes.
Specialized weighted complex survey design analysis software was employed for data analysis. Multivariate logistic regression models and restricted cubic splines (RCS) were utilized to assess the association between FI and OSA incidence in all participants. Additionally, a Cox proportional hazards model was established to estimate the association between FI and the hazard ratios (HRs) for all-cause mortality and cardiovascular disease (CVD) mortality.
A total of 8524 participants were included in this study. Compared to the Non-frail group (FI ≤ 0.1), OSA risk increased with higher FI levels. In Model 3, adjusted for multiple covariates, the Pro-frail group (0.1<FI ≤ 0.2) [odds ratio (OR) = 1.31, 95 % confidence interval (CI): (1.10, 1.56)], Mildly frail group (0.2<FI ≤ 0.3) [OR = 1.62, 95 % CI (1.28, 2.05)], and Moderately/Severely frail group (FI > 0.3) [OR = 2.32, 95 % CI (1.55, 3.48)] exhibited an average 31 %, 62 %, and 132 % increase in OSA risk, respectively. RCS results demonstrated a nonlinear dose-response relationship between OSA risk and FI levels, with an increasing trend (P = 0.004). The Cox model indicated that, except for the Pro-frail group, OSA-related mortality risk also increased with higher FI levels, with a more pronounced effect on CVD-related mortality.
This study supports the hypothesis that FI may be associated with an increased risk of OSA, with a higher emphasis on OSA-related mortality risk in Mildly frail and Moderately/Severely frail populations.
阻塞性睡眠呼吸暂停（OSA）的出现呈现出向年轻个体发展的趋势，但其发展轨迹仍不明朗，伴有复杂的预后影响。虽然虚弱和睡眠问题常常共存，但它们之间的关系仍不清楚。因此，本研究旨在利用2005年至2008年的美国国家健康与营养检查调查（NHANES）数据库，分析和探讨虚弱指数（FI）水平与OSA发病风险及生存结局之间的关系。
采用专门的加权复杂调查设计分析软件进行数据分析。利用多变量逻辑回归模型和限制性立方样条（RCS）评估所有参与者中FI与OSA发病率之间的关联。此外，建立Cox比例风险模型以估计FI与全因死亡率和心血管疾病（CVD）死亡率的风险比（HRs）之间的关联。
本研究共纳入8524名参与者。与非虚弱组（FI≤0.1）相比，OSA风险随FI水平升高而增加。在模型3中，经多个协变量调整后，虚弱前期组（0.1＜FI≤0.2）[比值比（OR）=1.31，95%置信区间（CI）：（1.10，1.56）]、轻度虚弱组（0.2＜FI≤0.3）[OR=1.62，95%CI（1.28，2.05）]和中度/重度虚弱组（FI＞0.3）[OR=2.32，95%CI（1.55，3.48）]的OSA风险分别平均增加31%、62%和132%。RCS结果显示OSA风险与FI水平之间存在非线性剂量反应关系，呈上升趋势（P=0.004）。Cox模型表明，除虚弱前期组外，OSA相关死亡风险也随FI水平升高而增加，对CVD相关死亡率的影响更为明显。
本研究支持FI可能与OSA风险增加相关的假设，在轻度虚弱和中度/重度虚弱人群中更强调OSA相关死亡风险。
