阻塞性睡眠呼吸暂停与代谢综合征:基于大样本临床数据库的相关性研究

Obstructive sleep apnea and metabolic syndrome:an association study based on a large sample clinical database

目的探索阻塞性睡眠呼吸暂停(OSA)患者中代谢综合征(metabolic syndrome,MS)的患病率及相关风险因素。方法回顾性分析2007年7月至2017年6月因疑患OSA于上海交通大学附属第六人民医院耳鼻咽喉头颈外科就诊的8155例成人受试者,其中男6484名,女1671名,年龄18~90(43.13±12.28)岁,体质量指数(BMI)14.61~59.56(25.59±3.98)kg/m2。所有患者接受多导睡眠监测及生化检验。按照OSA严重程度,将研究对象分为4组(非OSA,轻度OSA、中度OSA、重度OSA)。MS的患病率以百分比表示,采用校正性别、年龄、BMI、颈围、臀围、吸烟、饮酒等因素后的逻辑回归模型评估OSA及其特征病理生理指标与MS的相关性,并以优势比(odds ratio,OR)表示。采用SPSS 25.0软件进行统计学分析。结果MS总体患病率为43.6%,在非OSA、轻度OSA、中度OSA、重度OSA组的患病率为18.6%、30.4%、43.8%、57.1%。逻辑回归显示,轻度OSA、中度OSA、重度OSA组较非OSA组的MS患病风险增加,校正OR值及95%可信区间分别为1.27(1.05~1.54)、1.84(1.53~2.22)、2.08(1.76~2.46),P值均<0.01。此外,反映OSA缺氧负担的指标(氧降指数、最低血氧、血氧饱和度<90%累积时间比)与MS患病关系密切(t值分别7.1、56.3、10.6,P值均<0.01),睡眠片段化指标(觉醒指数)与MS患病无明显相关性。结论MS患病风险随OSA严重程度增加逐步增高,反映OSA缺氧负担的指标与MS患病密切相关。

Objective To investigate the prevalence and associated risk factors of metabolic syndrome(MS)in patients with obstructive sleep apnea(OSA).Methods From July 2007 to June 2017,a total of 8155 adult subjects,including 6484 males and 1671 females,aged 18-90(43.13±12.28),body mass index 14.61~59.56(25.59±3.98)kg/m2,who were admitted to the Department of Otorhinolaryngology head and Neck surgery of The Sixth People's Hospital affiliated to Shanghai Jiao Tong University,were retrospectively analyzed.All patients underwent polysomnography and biochemical tests.Subjects were divided into four groups(non-OSA,mild OSA,moderate OSA,and severe OSA)according to OSA severity.The prevalence of MS was expressed as percentage,and the correlation between OSA and MS and its characteristic pathophysiological indicators was evaluated by logistic regression model after adjusting for factors such as gender,age,BMI,neck circumference,hip circumference,smoking and alcohol consumption,and was expressed by odds ratio(OR).SPSS 25.0 software was used for statistical analysis.Results The overall prevalence of MS was 43.6%,and that of non-/mild/moderate/severe OSA group was 18.6%,30.4%,43.8%,57.1%.Logistic regression showed that patients with mild/moderate/severe OSA had an increased risk of MS compared with non-OSA patients,with adjusted OR values and confidence intervals of 1.27(1.05-1.54),1.84(1.53-2.22),and 2.08(1.76-2.46),respectively(P<0.01).In addition,indicators of OSA anoxic burden[oxygen drop index(Toxygen=7.1),minimum blood oxygen(Tminimum=56.3),blood oxygen saturation below 90%cumulative time ratio(TCT90=10.6)]were closely associated with MS disease(P<0.01),but sleep fragmentation index(arousals index)was not significantly associated with MS disease.Conclusion The risk of MS gradually increases with the severity of OSA,and the indicators reflecting OSA hypoxia burden are closely related to MS disease.