阻塞性睡眠呼吸暂停对南非农村地区老年人随机样本中心脏代谢健康的影响：为资源匮乏地区的睡眠障碍治疗提供依据。
Impact of obstructive sleep apnea on cardiometabolic health in a random sample of older adults in rural South Africa: building the case for the treatment of sleep disorders in underresourced settings.
作者信息
Roche Johanna, Rae Dale E, Redman Kirsten N, Knutson Kristen L, von Schantz Malcolm, Gómez-Olivé F Xavier, Scheuermaier Karine
机构信息
Wits Sleep Laboratory, Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
出版信息
J Clin Sleep Med. 2021 Jul 1;17(7):1423-1434. doi: 10.5664/jcsm.9214.
STUDY OBJECTIVES
The association between obstructive sleep apnea (OSA) and increased cardiometabolic risk (CMR) has been well documented in higher-income countries. However, OSA and its association with CMR have not yet been investigated, based on objective measures, in southern Africa. We measured polysomnography-derived sleep characteristics, OSA prevalence, and its association with cardiometabolic diseases in a rural, low-income, African-ancestry sample of older adult participants in South Africa.
METHODS
Seventy-five participants completed the study. Body mass index, hypertension, diabetes, dyslipidemia, and HIV status were determined. A continuous CMR score was calculated using waist circumference, random glucose, high-density-lipoprotein cholesterol, triglycerides, and mean arterial blood pressure. Sleep architecture, arousal index, and apnea-hypopnea index for detection of the OSA (apnea-hypopnea index ≥ 15 events/h) were assessed by home-based polysomnography. Associations between CMR score and age, sex, socioeconomic status, apnea-hypopnea index, and total sleep time were investigated by multivariable analysis.
RESULTS
In our sample (53 women, age 66.1 ± 10.7 years, 12 HIV+), 60.7% of participants were overweight/obese, 61.3% were hypertensive, and 29.3% had undiagnosed OSA. Being older (P = .02) and having a higher body mass index (P = .02) and higher waist circumference (P < .01) were associated with OSA. Apnea-hypopnea index severity (β = 0.011; P = .01) and being a woman (β = 0.369; P = .01) were independently associated with a higher CMR score in socioeconomic status- and age-adjusted analyses.
CONCLUSIONS
In this South African community with older adults with obesity and hypertension, OSA prevalence is alarming and associated with CMR. We show the feasibility of detecting OSA in a rural setting using polysomnography. Our results highlight the necessity for actively promoting health education and systematic screening and treatment of OSA in this population to prevent future cardiovascular morbidity, especially among women.
研究目的
阻塞性睡眠呼吸暂停（OSA）与心血管代谢风险（CMR）增加之间的关联在高收入国家已有充分记录。然而，基于客观测量，OSA及其与CMR的关联在非洲南部尚未得到研究。我们在南非一个农村低收入、具有非洲血统的老年参与者样本中，测量了多导睡眠图得出的睡眠特征、OSA患病率及其与心血管代谢疾病的关联。
方法
75名参与者完成了该研究。测定了体重指数、高血压、糖尿病、血脂异常和艾滋病毒感染状况。使用腰围、随机血糖、高密度脂蛋白胆固醇、甘油三酯和平均动脉血压计算连续的CMR评分。通过家庭多导睡眠图评估睡眠结构、觉醒指数和用于检测OSA的呼吸暂停低通气指数（呼吸暂停低通气指数≥15次/小时）。通过多变量分析研究CMR评分与年龄、性别、社会经济地位、呼吸暂停低通气指数和总睡眠时间之间的关联。
结果
在我们的样本中（53名女性，年龄66.1±10.7岁，12名艾滋病毒阳性），60.7%的参与者超重/肥胖，61.3%患有高血压，29.3%患有未确诊的OSA。年龄较大（P = 0.02）、体重指数较高（P = 0.02）和腰围较大（P < 0.01）与OSA相关。在社会经济地位和年龄调整分析中，呼吸暂停低通气指数严重程度（β = 0.011；P = 0.01）和女性（β = 0.369；P = 0.01）与较高的CMR评分独立相关。
结论
在这个有肥胖和高血压老年人的南非社区，OSA患病率令人担忧且与CMR相关。我们展示了在农村环境中使用多导睡眠图检测OSA的可行性。我们的结果强调了在该人群中积极促进健康教育以及对OSA进行系统筛查和治疗以预防未来心血管疾病发病的必要性，尤其是在女性中。
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