| 摘要: | 背景：阻塞型睡眠呼吸中止症（obstructive sleep apnea, OSA）逾三分之一比例的病患係屬於低覺醒閾值表現型(low arousal threshold phenotype,Low ArTH)，此類患者會因著較輕微的呼吸阻塞而覺醒，加劇睡眠碎片化（sleep fragmentation）的嚴重度。而目前對於Low ArTH OSA 症狀與病患的體組成特徵之關連性以及相關機轉尚待進一步研究，遂此本文旨就體脂肪、體水分布與呼吸事件期間持續期間、缺氧指數以及睡眠障礙等與疾病症狀的關連進行探討。
方法：回溯性整理新北市雙和醫院睡眠中心2924 位受試者資料，其中含括多項式睡眠生理檢查（polysomnography,PSG）與身體組成量測結果。依據現行Low ArTH OSA 臨床鑑別標準，篩選實驗組（Low ArTH OSA, n=1850）以及對照組 (non-OSA, n=368) 和（Non-low ArTH OSA, n=706）。使用統計分析比較三組各項目之平均值；以回歸模型分析身體組成變項對於PSG 參數與疾病嚴重度之關連性，以及罹患Low ArTH OSA 疾病的風險。
結果：實驗組（Low ArTH OSA）分別在年齡、細胞外液-內液比率項目具有較高的平均值（p<0.01）；細胞外液-內液比率之增加與淺呼吸時長呈現顯著線性負相關。在Low ArTH OSA 與non-OSA 兩組之間，經校正年齡、性別、身體質量指數(BMI)後，預測模型發現體脂肪比率、軀幹-四肢脂肪比率以及細胞外液-內液比率三項目與增高罹病風險有顯著關連性，其勝算比[信賴區間]（odds ratio, OR[CI]）依序為1.58 [1.08-2.3],1.22 [1.04-1.43],1.32 [1.08-1.62]；相同校正於Low ArTH OSA 與Non-low ArTH OSA 兩組之間，軀幹-四肢脂肪比率以及細胞外液-內液比率與增高Low ArTH OSA 風險有顯著關連性，其勝算比[信賴區間]（odds ratio, OR[CI]）分別為1.18[1.05-1.33],1.78 [1.52-2.09]。然而內臟脂肪水平與Low ArTH OSA 罹病風險之間無顯著的證據顯示有關連性。
結論：增加於軀幹處的脂肪以及細胞外液的分布是Low ArTH OSA 疾病之危險因子。
Among patients with obstructive sleep apnea (OSA), Low arousal threshold (low-ArTH) phenotype accounts for around one-third. The symptom, sleep fragmentation is exacerbated by causing minor respiratory events. Although anthropometric traits may affect low-ArTH OSA manifestations, the underlying mechanisms require more exploration. This study aimed to investigate the relationships between the distribution of body fat and water with low-ArTH OSA manifestations, such as respiratory event duration, oxygen desaturation details, and sleep disorder variables.
The data of 2924 patients, including baseline information, body composition and polysomnography (PSG) variables, were retrospectively obtained from a sleep center in northern Taiwan. The derived data were classified as those for low-ArTH in accordance with criteria that considered oximetry and the frequency and type fraction of respiratory events and analyzed using mean comparison and regression approaches.
The low-ArTH group (n=1850) had significantly higher values in age and the extracellular-to-intracellular (E-I) water ratio compared to the non-OSA group (n=368) and the Non-low ArTH OSA(n=706). Significant negative associations were found between E-I water ratio and hypopnea event duration. Compared to the non-OSA group, associations of body fat percentage (adjusted odds ratio [OR]: 1.58, 95% confident interval [CI]: 1.08 to 2.3, p < 0.05), trunk-to-limb fat ratio (adjusted OR: 1.22, 95% CI: 1.04 to 1.43, p < 0.05), and E–I water ratio (adjusted OR: 1.32, 95% CI: 1.08 to 1.62, p < 0.01) with the risk of low-ArTH OSA were noted after adjustments for sex, age, and body mass index. On the other hand, noted associations of trunk-to-limb fat ratio (adjusted OR: 1.18, 95% CI: 1.05 to 1.33, p < 0.01), and E–I water ratio (adjusted OR: 1.78, 95% CI: 1.52 to 2.09, p < 0.01) with the risk of low-ArTH OSA compared to Non-low ArTH OSA. No significant association was between visceral fat level and having low-ArTH OSA.
Our findings demonstrate that a rise in trunk body fat and extracellular water is associated with a higher risk of low-ArTH OSA presence. |
