打鼾与高甘油三酯血症关系的横断面研究
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摘要
目的:探讨不同打鼾特征(包括打鼾频次、打鼾声音强度)与中年人群高甘油三酯(TG)血症之间的关系。方法:利用1998年"中国心血管病流行病学多中心协作研究"对我国不同地区15组人群样本的横断面调查资料进行分析。研究从每组人群中整群抽样约1 000人,男女各半,年龄在35~59岁,进行心血管疾病危险因素调查,其中包括询问研究对象的打鼾情况(打鼾与否、打鼾频次及打鼾声音强度)。采用多因素Logistic回归分析探讨打鼾频次及打鼾声音与高TG血症的关系。结果:最终有14 175人纳入分析,根据打鼾频次所分的不打鼾、有时打鼾、经常打鼾、总是打鼾的四组人群,其高TG血症患病率依次为21.3%(1 808/8 486)、28.4%(901/3 169)、35.4%(525/1 484)、37.1%(384/1 036),呈明显上升趋势(趋势检验P<0.001);而且随着打鼾声音的增大,高TG血症患病率也呈明显上升趋势(趋势检验P<0.001)。多因素分析调整潜在混杂因素后,打鼾频次较高组高TG血症的患病风险明显增加,进一步调整体重指数后上述关联依然存在,与不打鼾组相比,有时、经常及总是打鼾组的人群高TG血症患病风险(OR)值及95%置信区间(CI)分别为1.12(1.01~1.24),1.34(1.18~1.52)和1.32(1.14~1.53),呈明显上升趋势(趋势检验P<0.001)。此外,打鼾声音强度也与高TG血症患病风险呈显著正相关(趋势检验P<0.001)。结论:我国中年人群打鼾频次越高,打鼾声音越大,高TG血症患病风险越高。
Objectives: To explore the relationship between different snoring characteristics(including snoring frequency, snoring sound intensity) and hypertriglyceridemia in middle-aged Chinese population.Methods: The data of 15 population samples from China Multicenter Collaborative Study of Cardiovascular Epidemiology(ChinaMUCA) conducted in 1998 were analyzed. Approximately 1 000 men and women aged 35 to 59 in each population were surveyed for cardiovascular risk factors, and participants' snoring habits(snoring frequency, snoring sound intensity). Multivariate logistic regression models were used to evaluating the relationship between snoring frequency, snoring sound intensity and hypertriglyceridemia.Results: A total of 14 175 participants were included in the analysis, according to the frequency of snoring, participants were divided into four groups, including never, occasionally(≤2 times/week), often(3-5 times/week), and always(6-7 times/week) snoring groups. The prevalence of hypertriglyceridemia in the above 4 groups was 21.3%, 28.4%, 35.4%, 37.1%, respectively(P for trend<0.001). The prevalence of hypertriglyceridemia increased significantly in proportion with the increase of snoring sound intensity(P for trend<0.001). After adjustment for potential confounding factors, the risk ofhypertriglyceridemia increased significantly in higher snoring frequency groups, and when body mass index was further adjusted in model 3, higher snoring frequency remained as an independent risk factor of hypertriglyceridemia. Comparing with never snoring group, the odds ratio and 95% confidence interval in occasionally, often, and always snorers were 1.12(1.01-1.24), 1.34(1.18-1.52), 1.32(1.14-1.53), respectively(P for trend <0.001). Moreover, snoring sound intensity also positively correlated with hypertriglyceridemia(P for trend <0.001). Conclusions: Both snoring frequency and snoring sound intensity positively correlate with the risk of hypertriglyceridemia in middle-aged Chinese population.
Objectives: To explore the relationship between different snoring characteristics(including snoring frequency, snoring sound intensity) and hypertriglyceridemia in middle-aged Chinese population.Methods: The data of 15 population samples from China Multicenter Collaborative Study of Cardiovascular Epidemiology(ChinaMUCA) conducted in 1998 were analyzed. Approximately 1 000 men and women aged 35 to 59 in each population were surveyed for cardiovascular risk factors, and participants' snoring habits(snoring frequency, snoring sound intensity). Multivariate logistic regression models were used to evaluating the relationship between snoring frequency, snoring sound intensity and hypertriglyceridemia.Results: A total of 14 175 participants were included in the analysis, according to the frequency of snoring, participants were divided into four groups, including never, occasionally(≤2 times/week), often(3-5 times/week), and always(6-7 times/week) snoring groups. The prevalence of hypertriglyceridemia in the above 4 groups was 21.3%, 28.4%, 35.4%, 37.1%, respectively(P for trend<0.001). The prevalence of hypertriglyceridemia increased significantly in proportion with the increase of snoring sound intensity(P for trend<0.001). After adjustment for potential confounding factors, the risk ofhypertriglyceridemia increased significantly in higher snoring frequency groups, and when body mass index was further adjusted in model 3, higher snoring frequency remained as an independent risk factor of hypertriglyceridemia. Comparing with never snoring group, the odds ratio and 95% confidence interval in occasionally, often, and always snorers were 1.12(1.01-1.24), 1.34(1.18-1.52), 1.32(1.14-1.53), respectively(P for trend <0.001). Moreover, snoring sound intensity also positively correlated with hypertriglyceridemia(P for trend <0.001). Conclusions: Both snoring frequency and snoring sound intensity positively correlate with the risk of hypertriglyceridemia in middle-aged Chinese population.
引文
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[15] Zhang N, Chen Y, Chen S, et al. Self-reported snoring is associated with dyslipidemia, high total cholesterol, and high low-density lipoprotein cholesterol in obesity:a cross-sectional study from a rural area of China[J]. Int J Environ Res Public Health, 2017, 14(1):e86. DOI:10.3390/ijerph14010086.
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[18] Olafiranye O,Adedayo AM. Obstructive sleep apnea and dyslipidemia:pathophysiological mechanisms[J]. Sleep Breath,2013, 17(2):445-445. DOI:10.1007/s11325-012-0773-4.
[19] Mcnicholas WT. Obstructive sleep apnea and inflammation[J].Prog Cardiovasc Dis,2009, 51(5):392-399. DOI:10.1016/j.pcad.2008.10.005.
[20] Drager LF, Jun J, Polotsky VY. Obstructive sleep apnea and dyslipidemia:implications for atherosclerosis[J]. Curr Opin Endocrinol Diabetes Obes,2010, 17(2):161-165. DOI:10.1097/MED.0b013e3283373624.
[21] Netzer NC, Stoohs RA, Netzer CM, et al. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome[J] Ann Intern Med,1999,131:485-491. DOI:10.7326/0003-4819-131-7-199910050-00002.
[22] Amra B, Rahmati B, Soltaninejad F, et al. Screening questionnaires for obstructive sleep apnea:an updated systematic review[J]. Oman Med J,2018, 33(3):184-192. DOI:10.5001/omj.2018.36.
[23]国家卫生和计划生育委员会疾病预防控制局.中国居民营养与慢性病状况报告.2015.北京:人民卫生出版社.
[2] Lin GM, Colangelo LA, Lloyd-Jones DM, et al. Association of sleep apnea and snoring with incident atrial fibrillation in the Multi-Ethnic Study of Atherosclerosis[J]. Am J Epidemiol, 2015, 182(1):49-57.DOI:10.1093/aje/kwv004.
[3] Marshall NS, Wong KK, Cullen SR, et al. Snoring is not associated with all-cause mortality, incident cardiovascular disease, or stroke in the Busselton Health Study[J]. Sleep, 2012, 35(9):1235-1240. DOI:0.5665/sleep.2076.
[4] Kohler M, Stradling JR. Mechanisms of vascular damage in obstructive sleep apnea[J]. Nat Rev Cardiol, 2010, 7(12):677-685.DOI:10.1038/nrcardio.2010.145.
[5] Botros N, Concato J, Mohsenin V, et al. Obstructive sleep apnea as a risk factor for type 2 diabetes[J]. Am J Med, 2009, 122(12):1122-1127. DOI:10.1016/j.amjmed.2009.04.026.
[6] Peppard PE, Young T, Palta M, et al. Prospective study of the association between sleep-disordered breathing and hypertension[J].N Engl J Med, 2000, 342(19):1378-1384. DOI:10.1056/NEJM200005113421901.
[7] Troxel WM, Buysse DJ, Matthews KA, et al. Sleep symptoms predict the development of the metabolic syndrome[J]. Sleep, 2010, 33(12):1633-1640. DOI:10.1093/sleep133.12.1633.
[8] Kim CE, Shin S, Lee HW, et al. Frequency of loud snoring and metabolic syndrome among Korean adults:results from the Health Examinees(HEXA)Study[J]. Int J Environ Res Public Health, 2017,14(11):e1294. DOI:10.3390/ijerph14111294.
[9] Sun L, Pan A, Yu Z, et al. Snoring, inflammatory markers, adipokines and metabolic syndrome in apparently healthy Chinese[J]. PLoS One, 2011, 6(11):e27515. DOI:10.1371/journal.pone.0027515.
[10]周龙,李莹,郭敏,等.成年早期体重状态及至中年时期体重变化与高甘油三酯血症的相关性研究[J].中国循环杂志,2015, 30(10):962-966. DOI:10.3969/j.issn.1000-3614.2015.10.009.
[11]国家“九五”科技攻关课题协作组.我国中年人群心血管病主要危险因素流行现状及从80年代初至90年代末的变化趋势[J].中华心血管病杂志,2001,29(2):74-79. DOI:10.3760/j:issn:0253-3758.2001.02.004.
[12]周北凡.心血管病流行病学调查方法手册.1997.北京:北京医科大学中国协和医科大学联合出版社.
[13]李莹,周北凡.大规模多中心协作研究中血脂测定的标准化[J].中国慢性病预防与控制,1996, 4:173-176.
[14]中国成人血脂异常防治指南修订联合委员会.中国成人血脂异常防治指南(2016年修订版)[J].中国循环杂志,2016, 16(10):7-28.DOI:10.3969/j. issn. 1000-3614.2016.10.00.
[15] Zhang N, Chen Y, Chen S, et al. Self-reported snoring is associated with dyslipidemia, high total cholesterol, and high low-density lipoprotein cholesterol in obesity:a cross-sectional study from a rural area of China[J]. Int J Environ Res Public Health, 2017, 14(1):e86. DOI:10.3390/ijerph14010086.
[16] Cho N, Joo S, Kim J, et al. Relation of habitual snoring with components of metabolic syndrome in Korean adults[J].Diabetes Res Clin Pract, 2006, 71(3):256-263. DOI:10.1016/j.diabres.2005.06.011.
[17] Shin MH, Kweon SS, Bo YC, et al. Self-reported snoring and metabolic syndrome:the Korean Multi-Rural Communities Cohort Study[J]. Sleep Breath, 2014, 18(2):423-430. DOI:10.1007/s11325-013-0902-8.
[18] Olafiranye O,Adedayo AM. Obstructive sleep apnea and dyslipidemia:pathophysiological mechanisms[J]. Sleep Breath,2013, 17(2):445-445. DOI:10.1007/s11325-012-0773-4.
[19] Mcnicholas WT. Obstructive sleep apnea and inflammation[J].Prog Cardiovasc Dis,2009, 51(5):392-399. DOI:10.1016/j.pcad.2008.10.005.
[20] Drager LF, Jun J, Polotsky VY. Obstructive sleep apnea and dyslipidemia:implications for atherosclerosis[J]. Curr Opin Endocrinol Diabetes Obes,2010, 17(2):161-165. DOI:10.1097/MED.0b013e3283373624.
[21] Netzer NC, Stoohs RA, Netzer CM, et al. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome[J] Ann Intern Med,1999,131:485-491. DOI:10.7326/0003-4819-131-7-199910050-00002.
[22] Amra B, Rahmati B, Soltaninejad F, et al. Screening questionnaires for obstructive sleep apnea:an updated systematic review[J]. Oman Med J,2018, 33(3):184-192. DOI:10.5001/omj.2018.36.
[23]国家卫生和计划生育委员会疾病预防控制局.中国居民营养与慢性病状况报告.2015.北京:人民卫生出版社.