高原重度阻塞性睡眠呼吸暂停低通气综合征与血清25(OH)D的相关性

Correlation analysis of serum 25(OH)D with severe obstructive sleep apnea hypopnea syndrome at altitude

目的探讨高原重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者25羟维生素D[25(OH)D]水平与睡眠监测指标的相关性。方法收集2021年6—12月在青海红十字医院睡眠医学中心行多导睡眠监测, 根据睡眠呼吸暂停低通气指数(AHI)诊断为重度OSAHS(AHI≥30次/h)的66例高原(海拔在1 800~4 193 m)居住≥1年的患者为试验组。另选取同期与试验组性别、年龄、民族、居住海拔等一般资料相匹配的健康志愿者进行多导睡眠监测, 最终纳入48例AHI<5次/h者为对照组。比较两组25(OH)D水平及其缺乏程度;将试验组按25(OH)D水平, 分为严重缺乏组[25(OH)D≤10 μg/L]、缺乏组[(10 μg/L<25(OH)D≤20 μg/L)]及非缺乏组[(25(OH)D>20 μg/L)], 比较三组间睡眠参数的差异;对可能影响重度OSAHS患者25(OH)D水平的因素进行相关性分析及多因素线性回归分析。结果共纳入114例居住在高原至少1年的成年人, 其中试验组66例, 对照组48例, 试验组及对照组全部研究对象均存在25(OH)D不足(≤30 μg/L), 两组25(OH)D水平[(13.13±4.05)比(13.68±4.60)μg/L, P=0.507]及缺乏程度差异均无统计学意义(均P>0.05)。试验组中, 25(OH)D非缺乏组, 快眼动(REM)睡眠时间及占比(REM%)、睡眠期觉醒时间均显著低于严重缺乏组(均P<0.05), 25(OH)D非缺乏组睡眠效率均显著高于严重缺乏组及缺乏组(均P<0.05)。Spearman相关性分析显示:试验组25(OH)D水平与血清钙离子水平(r=0.293, P=0.017)和睡眠效率(r=0.309, P=0.011)均呈正相关, 与年龄(r=-0.298, P=0.015)、REM睡眠时间(r=-0.401, P=0.001)、REM%(r=-0.421, P<0.001)、睡眠期觉醒时间(r=-0.362, P=0.003)均呈负相关。多因素线性回归分析提示:高原重度OSAHS中血清钙离子、REM睡眠时间、高血压病史是25(OH)D水平高低的预测因素。结论高原重度OSAHS患者睡眠监测指标与血清25(OH)D水平具有一定相关性, REM睡眠时间延长, 25(OH)D水平越低;同时高原重度OSAHS患者中, 共患病高血压与25(OH)D水平也有一定关系。

Objective To investigate the correlation between 25 hydroxyvitamin D[25(OH)D]level and sleep monitoring index in patients with severe altitude obstructive sleep apnea hypopnea syndrome(OSAHS).Methods Sixty-six patients with severe OSAHS(AHI≥30 times/hour)diagnosed by apnea hypopnea index(AHI)who had lived at high altitude(1800-4193 m)for≥1 year were included in the experimental group.The patients underwent polysomnography monitoring in Sleep Medicine Center of Qinghai Red Cross Hospital from June to December 2021.In addition,healthy volunteers matched the experimental group by gender,age,ethnicity and living altitude during the same period were selected for polysomnography monitoring.Finally,48 healthy volunteers with AHI<5 times/hour were included as the control group.25(OH)D level and its deficiency were compared between the two groups.The experimental group was further divided into severe deficiency group[25(OH)D≤10μg/L],the deficiency group[10μg/L<25(OH)D≤20μg/L]and the non-deficiency group[25(OH)D>20μg/L]according to 25(OH)D level,and the differences of sleep parameters among the three groups were compared.Correlation analysis and multifactor linear regression analysis were performed on the factors that may affect the level of 25(OH)D in patients with severe OSAHS.Results A total of 114 adults living on the plateau for at least one year were enrolled,including 66 in the experimental group and 48 in the control group.25(OH)D deficiency(≤30μg/L)was found in all the individuals included in the experimental group and the control group,and the 25(OH)D level of the two groups was[(13.13±4.05)vs(13.68±4.60)μg/L,P=0.507]and there was no significant difference in deficiency degree(all P>0.05).Within the experimental group,rapid eye movement(REM)sleep time and proportion(REM%)and sleep awakening time of 25(OH)D non-deficiency group,were significantly lower than those in severe deficiency group(all P<0.05),and sleep efficiency in 25(OH)D non-deficiency group was significantly higher than that in severe deficiency group and deficiency group(all P<0.05).Spearman correlation analysis showed that the level of 25(OH)D in experimental group were positively correlated with serum calcium ion level(r=0.293,P=0.017)and sleep efficiency(r=0.309,P=0.011),and were negatively correlated with age(r=-0.298,P=0.015),REM sleep time(r=-0.401,P=0.001),REM%(r=-0.421,P<0.001)and awakening time(r=-0.362,P=0.003).Multifactor linear regression analysis suggested that serum calcium,REM sleep time and history of hypertension were the predictors of 25(OH)D level in severe OSAHS at high altitude.Conclusions There is a correlation between sleep monitoring indexes and serum 25(OH)D level in patients with severe OSAHS at high altitude.The longer the REM sleep time,the lower the 25(OH)D level.Meanwhile,there is a certain relationship between co-morbidity hypertension and 25(OH)D level in patients with severe OSAHS at high altitude.