| BackgroundObstructive sleep apnea is characterized by the repeated collapse and reopening of the upper airway during sleep.The apnea and hypopnea associated with OSA are serious health hazards.Direct effects include intermittent hypoxia,sleep fragmentation,and excessive fluctuations in heart rate,blood pressure,and intrapleural pressure.These acute physical disorders evolve into long-term effects,such as cardiovascular and cerebrovascular diseases,cognitive impairment,reduced quality of life,and premature death.OSA is also associated with metabolic disorders,poor blood sugar control,and diabetes risk.OSA is common in adults.Gender,menopause,age and obesity significantly affected the occurrence and severity of OSA.Men,the elderly and obese are at higher risk.Dyslipidemia is an significant risk factor for cardiovascular diseases.OSA and dyslipidemia are common problems and both are associated with cardiovascular disease.Studies have shown that OSA combined with dyslipidemia significantly increase the incidence of atherosclerotic cardiovascular disease,especially severe OSA.There is increasing evidence that OSA is closely associated with metabolic abnormalities.The risk of cardiovascular disease associated with OSA may be mediated by metabolic abnormalities in OSA.It should be noted that most of the studies on OSA and dyslipidemia were not specifically designed to evaluate blood lipids,and most of the studies only focused on the relationship between OSA related indicators and dyslipidemia.Whether there is a relationship between OSA and lipid metabolism and which lipid components are associated with OSA is still controversial.At present,apnea hypopnea index(AHI)is used as the gold standard for diagnosing OSA and judging the severity of OSA.A large number of epidemiological and clinical studies have also used AHI as a predictor to explore the association between OSA and lipid metabolism disorders,and the results are often controversial and even contradictory.With the deepening of OSA research,OSA is gradually recognized as a heterogeneous disease,and the concept of"subtype" has been proposed.In recent years,OSA subtypes have attracted increasing attention.ObjectiveTo explore the difference of lipid metabolism disorder in OSA subtypes.To determine whether there are differences between these subtypes in dyslipidemia,attention should be paid to some "high-risk" OSA patients for early diagnosis and treatment to reduce the occurrence of cardiovascular and cerebrovascular complications.Method(1)A total of 1887 patients who underwent polysomnography(PSG)monitoring at the sleep center of the First Affiliated Hospital of Zhengzhou University from January 1,2017 to December 31,2020 were selected.After meeting the inclusion criteria and screening for exclusion criteria,a total of 1553 patients were eventually enrolled in the study.(2)We collected detailed basic information and clinical data of all patients meeting inclusion criteria,including hospitalization number,name,sex,age,height,weight,body mass index(BMI)and other information;clinical symptoms,smoking history,drinking history,menstrual history,hypertension,diabetes and other associated diseases,PSG monitoring results and blood lipid(total cholesterol(TC),triglycerides(TG),high-density lipoprotein(HDL),low-density lipoprotein(LDL)).The data were extracted from an electronic medical record system and recorded on a pre-designed questionnaire.EpiData3.1 software was used to input the above data into the database.(3)According to the severity of OSA,the enrolled patients were divided into mild,moderate and severe groups.Subjects were divided into different groups according to gender,age,and menopausal subtypes:male and female groups according to gender,non-elderly and elderly group according to age(<60 years old for the non-elderly group,≥60 years old for the elderly group),premenopausal women group and postmenopausal women group according to the menopausal status.They were also divided into non-obese group and obese group according to BMI(BMI<28 for non-obese group,≥28 for obese group),non-hypertensive group and hypertensive group according to whether they combined hypertension.(4)SPSS 22.0 was utilized for statistical analysis.The measurement data of normal distribution and non-normal distribution and categorical variables were expressed as x±s、M(P25,P75)and ratio,respectively.Continuous variables were compared using independent sample t test or Mann-Whitney U test between two groups,and using one-way ANOVA or Kruskal-Wallis test between three groups.Categorical variables were compared using Pearson χ2 test or Fisher’s exact test between two or three groups.The ordered variables were compared using Mann-Whitney U test between the two groups.For linear trend test,trend variance analysis was used for continuous variables and Mantel-Haenszel χ2 test was used for categorical variables.The risk factors of dyslipidemia were analyzed by binary logistic regression.P<0.05 was considered as statistically significant difference.Result(1)A total of 1553 OSA patients were screened by inclusion and exclusion criteria.There were 1285 males(82.7%)and 268 females(17.3%),aged from 18 to 91 years,with a BMI of 15.50 to 62.70 kg/m2.626 cases(40.3%)had a history of smoking and 599 cases(38.6%)had a history of drinking.There were 833 patients(53.6%)with hypertension,and 310 patients(20.0%)with diabetes.282 patients(18.2%)had hypercholesterolemia,797 patients(51.3%)had hypertriglyceridemia,826 patients(53.2%)had low HDL cholesterolemia,288 patients(18.5%)had hyper LDL cholesterolemia,and the proportion of dyslipidemia was 75.9%.(2)The level of TG and the prevalence of dyslipidemia gradually increased with OSA severity,while HDL gradually decreased with OSA severity(P<0.05).(3)Compared to the female group,the severity of OSA in male group was more severe,TG level and dyslipidemia ratio were higher,HDL was lower(P<0.05).(4)There was no significant difference in OSA severity between the non-elderly group and the elderly group(P>0.05).The level of TC,TG,LDL and dyslipidemia was higher in the non-elderly group,while HDL was lower(P<0.05).(5)OSA was more severe in postmenopausal women and HDL was lower in premenopausal women(P<0.05).(6)The OSA degree of obese group was more severe,the level of TG and dyslipidemia was higher than that of non-obese group,and HDL was lower than that of non-obese group(P<0.05).(7)Severe OSA(OR=1.381,95%CI:1.002-1.904,P=0.048),non-elderly(OR=2.952,95%CI:2.189-3.981,P<0.001),male(OR=2.319,95%CI:1.669-3.224,P<0.001),obesity(OR=1.739,95%CI:1.351-2.239,P<0.001),alcohol consumption(OR=1.587,95%CI:1.153-2.186,P 0.005)and diabetes(OR=1.750,95%CI:1.243-2.462,P=0.001)were independent risk factors for dyslipidemia in OSA patients(P<0.05).Conclusion(1)Dyslipidemia gradually increased with the severity of OSA.Severe OSA was independently associated with dyslipidemia.(2)Dyslipidemia was different among OSA subtypes.Dyslipidemia in OSA patients was correlated with gender,age and BMI.Dyslipidemia was more significant in non-elderly,male and obese patients.Comprehensive evaluation of OS A patients according to different subtypes can broaden our understanding of the heterogeneity of the relationship between OSA and dyslipidemia,and contribute to the management of cardiovascular disease risk factors in different populations. |
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