预防性服用阿司匹林与高尿酸血症之间的关系:基于NHANES数据库的分析

目的探究预防性服用阿司匹林对高尿酸血症(HUA)的影响,为HUA预防提供证据。方法采用横断面研究,纳入NHANES数据库2011-2018年收录的1898例成年人群,根据血清尿酸水平分为HUA组和对照组,收集预防性服用阿司匹林情况以及相关协变量。多因素logistic回归被用于分析预防性服用阿司匹林对HUA的影响,构建限制性立方样条(RCS)模型以明确阿司匹林服用剂量与HUA的剂量-反应关系。结果研究对象中共检出HUA患者406例(21.39%),HUA组预防性服用阿司匹林的比率(33.74%)高于对照组(24.06%),组间差异具有统计学意义(χ^(2)=15.499,P<0.01)。多因素logistic回归结果表明,在调整性别、年龄、种族、BMI、糖尿病史、肾脏虚弱/衰竭史、体力活动等协变量后,预防性服用阿司匹林仍然是HUA的独立危险因素(OR=1.553,95%CI:1.116~1.835)。RCS模型显示阿司匹林服用剂量与HUA呈正向线性相关(非线性P=0.895)。结论阿司匹林的预防性服用与HUA风险升高相关,应充分考虑患者的尿酸水平,在医生指导下合理使用阿司匹林。

牙周病和龋病相关性分析-基于NHANES数据库对真实世界的研究

目的:基于真实世界数据库探讨牙周病和龋病的相关性,为疾病诊疗和健康管理提供理论依据。方法:下载2011年至2014年美国国家健康和营养调查(NHANES)数据库中牙周病和龋病状况检查数据,按照疾病严重程度有序分组,采用广义有序Logistic回归模型进行相关性分析。结果:研究共纳入参与者6299例,轻度、中度和重度牙周炎发病率分别为42.34%、28.15%和11.53%;轻度、中度和重度龋病发病率分别为19.60%、28.34%和35.61%。对于牙周炎,年龄增长、低收入水平、男性、过度饮酒、糖尿病、高血压、中重度抽烟都是加重病情的危险因素。重度龋病和牙周病加重风险升高显著相关,轻度和中度龋病无显著影响。对于龋病,高血压、女性、低收入水平、年龄增长、重度抽烟都是加重病情的危险因素。所有类型牙周病都与龋病加重风险升高显著相关。结论:牙周病和龋病关联十分紧密,它们发生发展具有彼此促进作用,牙周病对龋病病情影响更大。

血清维生素D水平与心血管疾病的相关性研究:基于美国NHANES 2011~2020年数据

目的:探究血清维生素D水平与成人心血管疾病(Cardiovascular diseases, CVD)间的相关性。方法:使用美国国家健康和营养调查(national health and nutrition examination survey, NHANES) 2011~2020年数据进行分析,共纳入4802名20~80岁该项接受健康调查的成年人,采用方差分析和卡方检验进行相关统计学分析,采用回归模型探讨血清维生素D水平与CVD的关系。结果:与血清维生素D正常组相比,维生素D缺乏与CVD相关(OR = 1.32;95% CI = 1.03~1.69;P = 0.027)。维生素D不足、维生素D过量与CVD间无明显统计学意义(P > 0.05)。结论:避免过低的血清维生素D水平可能对心血管健康有潜在的好处。维生素D缺乏可能会带来更高的心血管疾病风险,其包括心力衰竭、冠心病、心绞痛和心肌梗死,而不足或过量的血清维生素D水平并不增加心血管疾病的发病风险。

基于NHANES数据库探讨美国成年人的久坐行为与自杀意念之间的关系

背景:该研究旨在调查美国成年人的久坐行为与自杀意念之间的关联。方法:这项横断面研究包括15,520名 ≥ 18岁的参加了2013~2018年全国健康和营养检查调查的参与者。使用患者健康问卷9 (PHQ9)的第9个问题评估参与者的自杀意念。久坐行为使用全球身体活动问卷进行测量。采用多个logistic回归模型和亚组分析对上述关系进行了研究。结果:在我们的研究中,美国成年人中3.60%的参与者有自杀意念。多变量logistic回归显示,在完全调整模型中,与久坐行为持续时间较短的参与者相比,久坐行为持续时间长的参与者产生自杀意念的风险高出1.04倍[1.04 (1.01, 1.06)]。通过亚组分析进一步验证久坐行为与自杀意念之间在不同人群中的关系。结论:我们的研究发现,在美国成年人中,久坐行为与自杀意念之间存在关联;然而,仍然需要具有更大样本量的前瞻性研究来确认久坐行为对美国成年人自杀意念的影响。

Association between NNAL and Mortality in U.S. Adults, NHANES 2007-2014 with 2015 Mortality Follow-Up

Cigarette smoking is a leading cause of premature mortality, attributable to chronic exposure to toxic compounds in cigarette smoke, including tobacco-specific nitrosamines, which are known carcinogens. This research aims to assess the association between NNAL, a metabolite of the tobacco-specific nitrosamine NNK, and mortality. Data from 14,766 U.S. adults aged 21 - 79 in the National Health and Nutrition Examination Survey (2007-2014) included smoking status and urinary NNAL concentration at the time of examination. These data were linked to participants’ subsequent mortality status as recorded in the public-use Linked Mortality File (through 2015). Cox proportional hazards regression models assessed the relative risk of all-cause, cancer, cardiovascular disease (CVD), and other-causes mortality for increasing levels of natural log (creatinine-adjusted NNAL). In the whole sample, a unit increase in log (NNAL) is associated with a 20% higher risk of all-cause (HR = 1.20;95% CI: 1.16 - 1.24), cancer (HR = 1.20;95% CI: 1.14 - 1.26), CVD (HR = 1.21;95% CI: 1.12 - 1.31) and other-causes (HR = 1.20;95% CI: 1.15 - 1.25) mortality. Among current smokers, a unit increase in log (NNAL) is associated with 44% higher cancer mortality risk (HR = 1.44;95% CI: 1.08 - 1.92) and a 96% higher CVD mortality risk (HR = 1.96;95% CI: 1.20 - 3.20). Risks of all-cause and other-causes mortality, but neither cancer nor CVD mortality, were positively associated with NNAL among never and former smokers. Inferences are limited by the observational nature of the data, and by the focus on a single biomarker of tobacco-related exposure. The findings suggest that urinary NNAL concentration is acting as a proxy for exposure to the toxicants in cigarette smoke rather than as a biomarker of disease-specific mortality risk.

NHANES项目介绍及数据提取流程

美国国家健康与营养调查(NHANES,National Health and Nutrition Examination Survey)是一项旨在评估美国成人和儿童健康和营养状况的研究计划,该调查的独特之处在于它结合了访谈和体检。NHANES是国家卫生统计中心(NCHS,National center for Health Statistics)的主要计划,是国家营养监测的基石,为营养和健康政策的制定提供了大量数据。NHANES项目信息及调查数据会在网站上及时更新且向公众免费开放。本文通过介绍NHANES项目相关内容及数据提取方法,方便需要的研究者快速高效地获取自己需要地数据。

Machine learning models for predicting non-alcoholic fatty liver disease in the general United States population:NHANES database

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is the most common chronic liver disease,affecting over 30% of the United States population.Early patient identification using a simple method is highly desirable.AIM To create machine learning models for predicting NAFLD in the general United States population.METHODS Using the NHANES 1988-1994.Thirty NAFLD-related factors were included.The dataset was divided into the training(70%)and testing(30%)datasets.Twentyfour machine learning algorithms were applied to the training dataset.The bestperforming models and another interpretable model(i.e.,coarse trees)were tested using the testing dataset.RESULTS There were 3235 participants(n=3235)that met the inclusion criteria.In the training phase,the ensemble of random undersampling(RUS)boosted trees had the highest F1(0.53).In the testing phase,we compared selective machine learning models and NAFLD indices.Based on F1,the ensemble of RUS boosted trees remained the top performer(accuracy 71.1%and F10.56)followed by the fatty liver index(accuracy 68.8% and F10.52).A simple model(coarse trees)had an accuracy of 74.9% and an F1 of 0.33.CONCLUSION Not every machine learning model is complex.Using a simpler model such as coarse trees,we can create an interpretable model for predicting NAFLD with only two predictors:fasting C-peptide and waist circumference.Although the simpler model does not have the best performance,its simplicity is useful in clinical practice.

Rice Consumption Is Associated with Better Nutrient Intake and Diet Quality in Adults: National Health and Nutrition Examination Survey (NHANES) 2005-2010

Objectives: The goal of this study was to determine the association of rice consumption with nutrient intake and diet quality in a recent nationally representative sample of US adults. Methods: NHANES data (2005-2010) were used to assess the association of rice consumption by adults (19+ yrs;N = 14,386) with nutrient intake and diet quality. 24-hour dietary intakes were used to calculate usual intake (UI) of rice consumption using the National Cancer Institute methodology. Rice consumption groups were 0.25 to 0.5 to <1.0, and >1.0 oz. eq. of UI of rice. Diet quality (using the Healthy Eating Index-2005 [HEI-2005]) was calculated. Covariate adjusted least square means ± SE were determined and quartile trends across the rice consumption categories were examined. Results: Significant (p < 0.001) positive trends (β coefficient across rice consumption categories) were seen for sodium (118.99 mg), dietary fiber (0.57 g), folate (58.24 μg DFE), magnesium (11.83 mg), iron (0.97 mg) and potassium (29.45 mg). Significant negative trends (p < 0.0001) were seen for intakes of saturated fatty acids (-1.75 g), added sugars (-1.31 g);and calcium (-40.46 mg). HEI-2005 also showed a positive trend (p < 0.0001) with rice consumption (5.5 points). HEI-2005 component scores for total fruit (0.07), whole fruit (0.11), dark green/orange vegetables (0.25), total grains (0.10), meat/beans (0.24), and oils (0.15) were higher (p < 0.01) in rice consumers than non-consumers. HEI-2005 component scores for saturated fatty acids (0.63), solid fats, added sugars, and alcohol (1.22) were higher suggesting more favorable intake, but sodium (-0.24) was lower. Conclusion: Overall, consumption of rice should be encouraged to improve nutrient intake and diet quality. Nutrition education can provide ways to reduce sodium added to rice dishes.

Association between Sleep Disturbances and Cardiovascular Diseases: Results from NHANES

Objectives: The relationship between sleep disturbances and cardiovascular disease (CVD) is not well established. This study assesses the association between sleep disturbances and CVD, and the effect of sleep duration on the relationship between sleep disturbances and CVD among adults in the United States (US). Design: Cross-sectional analysis. Setting: NHANES (National Health and Nutrition Examination Survey). Participants: A total of 5660 adults were included from the 2015-2016 cycle of the NHANES survey. Measurements: The main outcome was the presence of any CVD and included self-reported angina, congestive heart failure, coronary heart disease, hypertension and myocardial infarction. Associations between sleep disturbances and sleep duration with CVD were analyzed using logistic regression. Stratified models by sleep duration were used to assess effect modification. Results: We included 5660 participants (52.2% males), 32.7% of the participants reported having a disturbed sleep and 38% reported a CVD. Compared to those who did not report any sleep disturbances, those with sleep disturbance had 85% higher odds of CVD (OR 1.85, 95% CI 1.43 - 2.39). Similarly, there were 40% higher odds of CVD (OR 1.40, 95% CI 1.01 - 1.95) among those with shorter sleep duration compared with those that slept for 6 to 9hours. However, there was no evidence of effect modification by sleep duration. Conclusions: Our findings show that sleep disturbance is associated with higher odds of CVD. Clinicians and other healthcare providers need to consider the consequence of sleep disturbances and implement strategies in the treatment of patients with or at high risk of CVD.

Analysis of PFAS Levels and Associations with Adolescent Anthropometric Outcomes in NHANES

Perfluoroalkyl and polyfluoroalkyl substances (PFAS) are found in some consumer products due to their heat resistance and durability. However, there is potential for these substances to bioaccumulate in humans. It is relevant to investigate biological effects of these chemicals, as studies have suggested early life exposure may impact human developmental outcomes such as infant birth weight and youth adiposity. The objective of the current study was to determine if a relationship exists between increasing levels of certain PFAS and anthropometrics in adolescents ages 12 - 18. The three PFAS examined were: perfluorodecanoic acid (PFDeA), 2-(N-methyl-perfluoroctane sulfonamido) acetic acid (Me-PFOSA-AcOH), and perfluoroundecanoic acid (PFUA). The data was obtained from the National Health and Nutrition Examination Survey (NHANES) from the years 2011-2012 (N = 287) and 2013-2014 (N = 344). An additional analysis combined data from 3 NHANES survey cycles using sampling weights for the years 2011-2016 (N = 875) to generate a larger sample size of detectable PFAS. PFAS concentrations were classified as above or below the lower limit of detection (LLOD) to evaluate differences in weight, waist circumference, BMI (body mass index), and height using Student’s t-tests. These same anthropometric outcomes were examined as continuous variables in linear regression models and were stratified by sex. In the 2013-2014 dataset, there were significant inverse associations between female concentrations of PFUA and PFDeA with waist circumference (PFUA β = −0.056;95% CI, −0.106, −0.005;PFDeA β = −0.06;95% CI, −0.10, −0.02), weight-for-age z-score (PFUA β = −0.40;95% CI, −0.74, −0.05;PFDeA β = −0.38;95% CI, −0.64, −0.12), and BMI-for-age z-score (PFUA β = −0.48;95% CI, −0.86, −0.10;PFDeA β = −0.45;95% CI, −0.73, −0.16). In the 2011-2012 dataset, males displayed a significant inverse relationship between PFDeA and waist circumference (β = −0.08;95% CI, −0.14, −0.02), weight-for-age z-score (β = −0.49;95% CI, −0.88, −0.11), and BMI-for-age z-score (β = −0.44;95% CI, −0.84, −0.05). In the combined analysis of NHANES years 2011-2016, there were significant inverse associations with PFUA and PFDeA and weight-for-age z-score, waist circumference, and BMI-for-age z-score. In the given sample years, there was no compelling evidence for a relationship between any of the perfluoroalkyl chemicals and height, nor between Me-PFOSA-AcOH and any of the body measures after adjusting for age, sex, and race/ethnicity. This suggests that PFUA and PFDeA exposure in adolescents may be related to smaller waist circumference, weight, and BMI, but longitudinal studies are recommended to confirm these findings.

美国成年人中谷丙转氨酶不明原因的升高与血清瘦素之间的关系:结果来自第三次国家健康和营养调查报告(NHANESⅢ)

Introduction: There has been an interest to explore whether serum leptin plays any role in the pathogenesis of chronic liver disease. We conducted a case-control study to evaluate the relationship between unexplained elevations in ALT and serum leptin in NHANES III participants. Methods: A total of 6343 adults who had fasting serum leptin and ALT measured as part of NHANES III constituted our study group. From this database, we have constructed cohorts of patients with unexplained elevations in ALT according to published criteria and compared their serum leptin levels to matched controls without liver disease and matched controls with hepatitis C. Leptin was also compared between patients with unexplained elevations in ALT with and without metabolic syndrome. Results: Serum leptin in 288 patients with unexplained elevations in ALT was 13.3 ±9.9 ng/mL and was not significantly different than 720 controls without liver disease (13.6 ±11.9 ng/mL, P = 0.6). Serum leptin in another group of patients with unexplained elevations in ALT and hepatitis C controls was also not significantly different (8.0 ±4.8 vs. 8.8 ±7.4 ng/mL, respectively, P = 0.5). There was no independent relationship between the presence of metabolic syndrome and serum leptin in individuals with unexplained elevations in ALT (P = 0.8). Conclusions: Individuals with unexplained elevations in ALT did not have higher levels of serum leptin than the matched controls. As unexplained elevations in ALT may signify the presence of non-alcoholic fatty liver disease in NHANES III participants, our data provide indirect evidence against a role for serum leptin in the pathogenesis of nonalcoholic fatty liver disease.

Serum monoterpene levels, glucose homeostasis, lipid profiles, and metabolic syndrome in adults: NHANES, 2013–2014

Monoterpenes are organic compounds which have been studied for their medicinal benefits.However,the association between monoterpene exposure and metabolic parameters in humans is unknown.We investigated the connection between three specific monoterpenes(α-pinene,β-pinene,and limonene),glucose homeostasis biomarkers,lipid profiles,and metabolic syndrome(MS)in 1627 adults from the National Health and Nutrition Examination Survey(NHANES)2013–2014.We found serum levels ofα-pinene andβ-pinene were positively associated with fasting glucose,total cholesterol,triglyceride,and apolipoprotein B.In addition,increased levels of limonene andΣmonoterpene(sum of three monoterpene chemicals)were linked to higher insulin,β-cell function,total cholesterol,low density lipoprotein cholesterol(LDL-C),triglycerides,and apolipoprotein B.Participants with all three monoterpenes above the 50th percentile had notably higher values for total cholesterol and triglycerides compared to those with all three monoterpenes below the 50th percentile(P for trend<0.001).Regarding MS,higher serum concentrations ofα-pinene were linked to an increased risk of high-density lipoprotein cholesterol(HDL-C)insufficiency and hypertriglyceridemia.Elevated concentrations ofβ-pinene were associated with a higher prevalence of hypertriglyceridemia.Moreover,increased levels of limonene andΣmonoterpene were connected to a higher risk of MS,larger waist circumference,low HDL-C,hypertriglyceridemia,and higher blood pressure according to MS criteria.In conclusion,serum monoterpenes levels were linked to glucose regulation,lipid profiles,and indicators of MS.Further studies are necessary to clarify the potential causal relationships.

预后营养指数对脑卒中后抑郁风险的影响:基于NHANES 2017—2020年的横断面调查

目的探讨预后营养指数(prognostic nutritional index,PNI)与脑卒中患者抑郁风险的关系,为脑卒中患者预后管理提供参考。方法选取美国国家健康和营养调查(National Health and Nutrition Examination Survey,NHANES)数据库2017—2020年收录的脑卒中后幸存者作为研究对象,评估其抑郁情况并计算PNI,采用多因素logistic回归分析PNI对脑卒中患者抑郁风险的影响。结果共纳入443例研究对象,包括男性220例,女性223例,平均年龄(65.22±12.44)岁,共检出抑郁95例(21.44%)。脑卒中后抑郁患者PNI指数为(47.23±7.01)分,低于非抑郁患者的(49.59±5.51)分,组间差异有统计学意义(P<0.05)。多因素logistic回归结果显示,在调整性别、年龄、教育水平、婚姻状态、吸烟史等混杂因素后,PNI评分升高对脑卒中后抑郁有明显的保护作用(OR=0.929,95%CI:0.892~0.968,P<0.05)。结论PNI评分升高对降低脑卒中患者抑郁风险具有一定作用,维持良好的营养状态和免疫功能对于预防脑卒中患者抑郁、改善预后效果具有重要意义。

预后营养指数与肾结石发病风险的关联性分析:基于NHANES的数据分析结果

目的:肾结石是泌尿外科常见病,治疗后的复发率高达50%。据报道,结石的发病受营养状态的影响。因此,本文选择了美国国家健康与营养调查(NHANES)数据库研究预后营养指数(PNI)对肾结石发病的影响。方法:本研究利用2007—2018年的美国NHANES人群数据,首先进行了人群的筛选和数据提取。参考既往研究,将纳入人群根据PNI按照四分位法从小到大分为Q1~Q4四组。最后使用STATA软件进行单因素和多因素的回归分析。结果:研究共纳入了30265例研究对象,其中肾结石患者2889例,平均年龄(47.6±0.23)岁,平均PNI为(53.4±0.07),男性比例48.8%,肥胖人群占29.5%。分析显示,以Q1为参考,Q4的单、多因素分析均显示肾结石发病风险显著降低(OR=0.65,95%CI:0.56~0.75,P<0.001;OR=0.79,95%CI:0.67~0.94,P=0.007)。结论:较高的PNI指数和较低的肾结石发病相关。因此,维持良好的营养状态,特别是白蛋白的水平可能有利于预防结石的发生。

基于NHANES数据库的银屑病与皮肤癌的相关性分析

探讨银屑病与皮肤癌的相关性。方法 合并2009-2014年的美国国家健康与营养调查数据,筛选出14838例纳入研究,按照是否有银屑病分为两组,银屑病组417例(2.81%),无银屑病组14421例(97.19%)。描述统计研究对象的基本人口学信息、患皮肤癌情况,采用卡方检验比较组间差异。采用二元logistics回归模型分析银屑病和皮肤癌的关系。结果 在没有纳入协变量的模型一中,与无银屑病组相比,银屑病组的非黑色素瘤皮肤癌风险增加,OR=2.985(95%CI:1.976-4.509);模型二纳入了所有协变量,包括性别、年龄、种族、学历、贫困比率。结果显示,与无银屑病组相比,银屑病组的非黑色素瘤皮肤癌风险增加,OR=2.517(95%CI:1.643-3.857)。无论是模型一还是模型二,银屑病与黑色素瘤均无关(P>0.05)。结论 银屑病可能与非黑色素瘤皮肤癌风险增加相关。

美国2型糖尿病患者血浆致动脉粥样硬化指数(AIP)与肝脂肪变性和肝纤维化之间的关联:一项大型横断面研究

目的:血浆致动脉粥样硬化指数(AIP)是反映脂质代谢的新指标。2型糖尿病(T2DM)是发生非酒精性脂肪肝(NAFLD)的高危因素。本研究的主要目的是探讨AIP与美国T2DM患者肝脏脂肪变性和肝纤维化之间的潜在相关性。方法:使用2017~2020年全国健康与营养检查调查(NHANES)的数据集进行横断面调查。构建三个模型,采用回归分析检验AIP与受控衰减参数(CAP)、肝脏硬度测量(LSM)以及NAFLD之间的线性关系,将AIP划分四个等级并进行趋势性检验。采用限制性立方样条图(RCS)来描述它们之间的非线性关系。以上所有统计分析都经过加权处理。结果:这项以美国T2DM患者为基础的研究纳入1170人。在多元线性回归和逻辑回归分析中,AIP*10与CAP [β (95% CI), 3.18 (0.41~5.96), P = 0.033]、NAFLD [OR (95% CI), 1.16 (1.02~1.33), P = 0.035]均呈显著正相关,趋势性检验存在统计学意义,但AIP与LSM [β (95% CI), 0.04 (−1.35~1.42), P = 0.947]的关系并不显著。RCS分析显示AIP和CAP之间呈S型非线性关系(P-overall < 0.001, P-non-linear = 0.036),并且随着AIP的升高,男性比女性有更严重的肝脏脂肪变。结论:AIP与T2DM患者肝脏脂肪变性之间存在显著正相关,它或许可以成为预测NAFLD发生的一项无创指标。然而,并未发现AIP与肝纤维化之间存在任何关联。

叶酸水平与美国65岁以上老年男性良性前列腺增生的关联性分析

目的:良性前列腺增生(BPH)是中老年男性常见病,叶酸水平可能与年龄有关。因此,本研究旨在分析叶酸与BPH之间的关系。方法:选取美国国家健康与营养检查调查(NHANES)数据库2001—2008年数据,根据既往研究,将叶酸按照五分位法分为Q1~Q5五组,用统计软件R和Free statistics进行多因素Logistic回归分析和亚组分析。结果:研究最终纳入886名参与者,其中690例(77.9%)患有良性前列腺增生,平均年龄(68.1±10.6)岁。分析显示,在调整了潜在的混杂因素后,与最低五分位(Q1)相比,高水平血清叶酸和红细胞叶酸与BPH发生风险增加相关(OR=2.07,95%CI:1.14~3.75,P=0.016;OR=1.73,95%CI:1.01~2.96,P=0.047),而膳食叶酸没有(OR=1.36,95%CI:0.78~2.38,P=0.279)。亚组分析显示,在年龄>65岁的亚组中,高水平血清叶酸和红细胞叶酸与BPH发生风险增加相关(OR=2.38,95%CI:1.2~4.74,P=0.014;OR=2.31,95%CI:1.22~4.39,P=0.01)。结论:在美国老年男性个体中,高水平血清叶酸和红细胞叶酸可能是BPH的危险因素。

成人阻塞性睡眠呼吸暂停与耳鸣的关联性研究

目的:探讨美国20~69岁成人中阻塞性睡眠呼吸暂停(OSA)与耳鸣的关系。方法:采用2015~2016年美国国家健康与营养检查调查(NHANES)的数据,纳入了具有完整研究数据和混杂因素信息的参与者。采用多因素logistic回归分析和亚组分析探讨OSA与耳鸣的关系。结果:研究共纳入3175名参与者。调整所有协变量后,多因素logistic回归显示OSA与耳鸣相关(OR = 1.52, 95% CI 1.16~1.99)。在亚组分析中,男性和女性均发现OSA与耳鸣相关(P < 0.05)。结论:在本研究中,我们发现OSA与耳鸣有关。因此,OSA是耳鸣的危险因素之一。