吸烟与OSA严重程度的相关性研究

Relationship between smoking and the severity of OSA

目的:探讨吸烟与OSA严重程度之间的关系。方法:719例患者纳入研究,均有打鼾、憋气、白天嗜睡等症状,符合纳入排除标准。均接受整夜PSG监测,监测指标包括AHI、SaO2、氧减指数、微觉醒指数等;完成包括吸烟史在内的问卷调查、Epworth嗜睡量表填写;进行人体生理学数据(包括体重、身高、颈围、腰围、臀围等)测量。以AHI判定OSA的严重程度:<5为正常,5~15为轻度,>15~30为中度,>30为重度。以吸烟指数判定吸烟的严重程度:轻度吸烟为<200,中度吸烟为200~400,重度吸烟为>400。结果:719例患者中,非OSA者138例,OSA者581例;不吸烟者381例,吸烟者279例,已戒烟者59例。OSA组的吸烟率为41.5%,非OSA组为27.5%,OSA组的吸烟率显著高于非OSA组(P<0.01)。在剔除59例戒烟患者后,将剩余660例患者按吸烟情况分为不吸烟组、轻度吸烟组、中度吸烟组和重度吸烟组,每组再根据AHI分为非OSA组、轻度OSA组、中度OSA组和重度OSA组,结果发现吸烟严重程度与OSA严重程度间存在明显正相关(r=0.203,P<0.01);在矫正年龄、BMI和腰臀比等混杂因素后,两者之间仍有明显相关性(r=0.141,P<0.01);有序Logistic回归分析显示,在矫正年龄、BMI和腰臀比后,与不吸烟组相比,中度吸烟组和重度吸烟组发生OSA的风险分别增加1.72倍(OR=1.72,95%CI 1.08~2.75)和2.68倍(OR=2.68,95%CI 1.61~4.46)。结论:吸烟的严重程度与OSA严重程度之间存在正相关,吸烟程度重的患者发生OSA的风险增加,这种相关性独立于年龄及肥胖等危险因素。

Objective:To explore the relationship between smoking and the severity of OSA.Method:There were 719 patients included in the study,who were accompanied by snoring,daytime sleepiness and other symptoms.Laboratory-based polysomnographic variables(including AHI,oxygen desaturation index and microarousal index,etc.),and anthropometric measurements(including weight,neck circumference,waist circumference,hip circumference etc.)were collected for all participants.The severity of OSA was determined by AHI.No OSA was defined as AHI<5,mild OSA as AHI of 5 to 15,moderate OSA as AHI of>15 to 30,and severe OSA as AHI of>30.Smoking severity was determined by the smoking index(SI).Light smoke was defined as SI<200,moderate smoke was as SI 200 to 400,and severe smoke as SI>400.Result:There were 138 cases of non-OSA and 581 cases of OSA.There were 381 non-smokers,279 smokers and 59 quit smokers.The smoking rate of OSA group was significantly higher than that of non-OSA group(41.5%vs.27.5%,P<0.01).After excluding59 quit smokers,the remaining 660 subjects were divided into four groups according to the severity of smoking,then each group was further divided into four groups according to OSA severity.Unadjusted analysis showed that OSA severity positively correlated with smoking severity(r=0.203,P<0.01).The positive correlation remained significant after further adjustment for age,BMI and waist-hip ratio.In addition,logistic regression analysis showed that compared to non-smokers,the odd ratios for OSA in moderate smokers were 1.72(95%CI 1.08-2.75)and in severe smokers were 2.68(95%CI 1.61-4.46),after adjustment for age,BMI and waist-hip ratio.Conclusion:The severity of smoking significantly correlated with the severity of OSA.There was increased risk of OSA in patients with severe smoke.The correlation was independent of some confounders such as age and o besity.