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Park IR, Chung YG, Chung SM, Moon JS, Yoon JS, Won KC. Association between obstructive sleep apnea risk and atherosclerosis: A nationwide cross-sectional study in the Korean population. PLoS One 2025; 20:e0322897. [PMID: 40341843 PMCID: PMC12061421 DOI: 10.1371/journal.pone.0322897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Accepted: 03/29/2025] [Indexed: 05/11/2025] Open
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) increases the risk of all-cause and cardiovascular mortality. This study aimed to investigate the association between OSA and atherogenic risk in the Koreans. METHODS Data from 8,158 participants (mean age, 57.9 ± 11.7; male/female, 1:1.4) obtained from the Korea National Health and Nutrition Examination Survey between 2019 and 2021. OSA risk was screened using the STOP-BANG score, and atherogenic risk was measured using the atherogenic index of plasma (AIP). Logistic regression was used to evaluate the association between the STOP-BANG scores and high AIP and subgroups according to the presence of diabetes. RESULTS The proportions of individuals with atherogenic risk (AIP > 0.24) were 13.7%, 27.6%, and 34.7% in the low-, intermediate-, and high-OSA risk groups (p < 0.001). After adjustment, individuals with intermediate and high OSA risk had 1.35 (95% confidence interval [CI], 1.16-1.58; p < 0.001) and 1.32 (95% CI, 1.08-1.61; p = 0.006) times higher odds of having atherogenic risk than those with low OSA risk. Among patients without diabetes, high OSA risk was not an independent factor affecting atherogenic risk (hazard ratio [HR], 1.17; 95% CI, 0.93-1.47). However, among patients with diabetes, compared with those with low OSA risk, those with intermediate (HR, 1.51; 95% CI, 1.05-2.19) and high OSA risk (HR, 1.58; 95% CI, 1.02-2.46) had significantly increased atherogenic risk. CONCLUSION OSA is linked to increased atherogenic risk in the Koreans, especially in individuals with diabetes, thus highlighting the importance of routine OSA screening to manage and reduce cardiovascular risks.
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Affiliation(s)
- Il Rae Park
- Department of Intermal Medicine, Yeungnam University College of Medicine, Daegu
| | - Yong Geun Chung
- Department of Intermal Medicine, Yeungnam University College of Medicine, Daegu
| | - Seung Min Chung
- Department of Intermal Medicine, Yeungnam University College of Medicine, Daegu
| | - Jun Sung Moon
- Department of Intermal Medicine, Yeungnam University College of Medicine, Daegu
| | - Ji Sung Yoon
- Department of Intermal Medicine, Yeungnam University College of Medicine, Daegu
| | - Kyu Chang Won
- Department of Intermal Medicine, Yeungnam University College of Medicine, Daegu
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Gong L, Su M, Xu JH, Peng ZF, Du L, Chen ZY, Liu YZ, Chan LC, Huang YL, Chen YT, Huang FY, Piao CL. Cross-sectional study of the association between triglyceride glucose-body mass index and obstructive sleep apnea risk. World J Diabetes 2025; 16:98519. [PMID: 40093293 PMCID: PMC11885970 DOI: 10.4239/wjd.v16.i3.98519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 09/10/2024] [Accepted: 12/27/2024] [Indexed: 01/21/2025] Open
Abstract
BACKGROUND The triglyceride glucose-body mass index (TyG-BMI) is a novel indicator of insulin resistance (IR). Obstructive sleep apnea (OSA) is a prevalent disorder characterized by recurrent complete or partial collapse of the pharyngeal airway during sleep; however, the relationship between these two conditions remains unexplored. We hypothesized that a higher TyG-BMI is associated with the occurrence of OSA. AIM To assess the association between TyG-BMI and OSA in adults in the United States. METHODS A cross-sectional study was conducted utilizing data from the National Health and Nutrition Examination Surveys spanning from 2005-2008 to 2015-2018. TyG-BMI was calculated as Ln [triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2] × BMI. Restricted cubic splines were used to analyze the risk of TyG-BMI and OSA occurrence. To identify potential nonlinear relationships, we combined Cox proportional hazard regression with smooth curve fitting. We also conducted sensitivity and subgroup analyses to verify the robustness of our findings. RESULTS We included 16794 participants in the final analysis. Multivariate regression analysis showed that participants with a higher TyG-BMI had a higher OSA incidence. After adjusting for all covariates, TyG-BMI was positively correlated with the prevalence of OSA (odds ratio: 1.28; 95% confidence interval: 1.17, 1.40; P < 0.001); no significant nonlinear relationship was observed. Subgroup analysis showed no strong correlation between TyG-BMI and OSA in patients with diabetes. The correlation between TyG-BMI and OSA was influenced by age, sex, smoking status, marital status, hypertensive stratification, and obesity; these subgroups played a moderating role between TyG-BMI and OSA. Even after adjusting for all covariates, there was a positive association between TYG-BMI and OSA prevalence. CONCLUSION A higher TyG-BMI index is linked to higher chances of developing OSA. As TyG-BMI is an indicator of IR, managing IR may help reduce the risk of OSA.
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Affiliation(s)
- Li Gong
- Department of Diabetes, Shenzhen Bao'an Chinese Medicine Hospital Guangzhou University of Chinese Medicine, Shenzhen 518100, Guangdong Province, China
| | - Ming Su
- Department of Pneumology, Shenzhen Bao'an Chinese Medicine Hospital Guangzhou University of Chinese Medicine, Shenzhen 518100, Guangdong Province, China
| | - Jing-Han Xu
- Department of Endocrinology, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen 518100, Guangdong Province, China
| | - Zhen-Fei Peng
- Department of Diabetes, Shenzhen Bao'an Chinese Medicine Hospital Guangzhou University of Chinese Medicine, Shenzhen 518100, Guangdong Province, China
| | - Lin Du
- Department of Endocrinology, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen 518100, Guangdong Province, China
| | - Ze-Yao Chen
- Department of Endocrinology, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen 518100, Guangdong Province, China
| | - Yu-Zhou Liu
- Department of Diabetes, Shenzhen Bao'an Chinese Medicine Hospital Guangzhou University of Chinese Medicine, Shenzhen 518100, Guangdong Province, China
| | - Lu-Cia Chan
- Department of Endocrinology, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen 518100, Guangdong Province, China
| | - Yin-Luan Huang
- Department of Diabetes, Shenzhen Bao'an Chinese Medicine Hospital Guangzhou University of Chinese Medicine, Shenzhen 518100, Guangdong Province, China
| | - Yu-Tian Chen
- Department of Diabetes, Shenzhen Bao'an Chinese Medicine Hospital Guangzhou University of Chinese Medicine, Shenzhen 518100, Guangdong Province, China
| | - Feng-Yi Huang
- Department of Diabetes, Shenzhen Bao'an Chinese Medicine Hospital Guangzhou University of Chinese Medicine, Shenzhen 518100, Guangdong Province, China
| | - Chun-Li Piao
- Department of Endocrinology, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen 518100, Guangdong Province, China
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Adeva-Andany MM, Adeva-Contreras L, Carneiro-Freire N, Ameneiros-Rodríguez E, Vila-Altesor M, Calvo-Castro I. The impact of high altitude (hypobaric hypoxia) on insulin resistance in humans. J Physiol Biochem 2025; 81:35-55. [PMID: 40019670 DOI: 10.1007/s13105-025-01069-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Accepted: 01/30/2025] [Indexed: 03/01/2025]
Abstract
Exposure to hypobaric hypoxia (high altitude) diminishes systemic tissue oxygenation. Tissue hypoxia induces insulin resistance and a metabolic switch that reduces oxidative phosphorylation and glucose storage while enhancing glycolysis. Similarly to hypobaric hypoxia, insulin resistance develops in normal humans undergoing normobaric hypoxia and in patients with obstructive sleep apnea. Following acute exposure to high altitude, insulin resistance returns to baseline values upon returning to sea level or when compensatory mechanisms restore tissue oxygenation. However, insulin resistance persists in subjects unable to achieve sufficient oxygen delivery to tissues. Likewise, long-term residents at high altitude develop persistent insulin resistance when compensatory mechanisms do not attain adequate tissue oxygenation. Among these subjects, insulin resistance may cause clinical complications, such as hypertriglyceridemia, reduced HDL-c, visceral obesity, metabolic dysfunction-associated steatotic liver disease, essential hypertension, type 2 diabetes, subclinical vascular injury, cardiovascular disease, and kidney disease. Impaired tissue oxygenation allows the stabilization of hypoxia-inducible factor-1 (HIF-1), a transcription factor that modulates the transcriptional activity of a number of genes to coordinate the physiological responses to tissue hypoxia. Among them, HIF-1 downregulates PPARG, that codes peroxisome proliferator-activated receptor-gamma (PPAR-γ) and PPARGCA, that codes PPAR-γ coactivator-1α, in order to enable insulin resistance and the metabolic switch from oxidative phosphorylation toward glycolysis.
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Affiliation(s)
- María M Adeva-Andany
- Internal Medicine Department, Hospital General Juan Cardona, c/ Pardo Bazán s/n, Ferrol, 15406, Spain.
| | - Lucia Adeva-Contreras
- School of Medicine, Santiago de Compostela University, Santiago de Compostela, Galicia, Spain
| | - Natalia Carneiro-Freire
- Internal Medicine Department, Hospital General Juan Cardona, c/ Pardo Bazán s/n, Ferrol, 15406, Spain
| | - Eva Ameneiros-Rodríguez
- Internal Medicine Department, Hospital General Juan Cardona, c/ Pardo Bazán s/n, Ferrol, 15406, Spain
| | - Matilde Vila-Altesor
- Internal Medicine Department, Hospital General Juan Cardona, c/ Pardo Bazán s/n, Ferrol, 15406, Spain
| | - Isabel Calvo-Castro
- Internal Medicine Department, Hospital General Juan Cardona, c/ Pardo Bazán s/n, Ferrol, 15406, Spain
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Zhou Y, Xue F. Exploring the Association Between Triglyceride-Glucose Indices and Their Derivatives With Obstructive Sleep Apnea: Insights From the National Health and Nutrition Examination Survey. Nat Sci Sleep 2025; 17:143-155. [PMID: 39872223 PMCID: PMC11771171 DOI: 10.2147/nss.s487596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 01/17/2025] [Indexed: 01/30/2025] Open
Abstract
Background Simple and affordable methods for evaluating Insulin Resistance (IR) have been suggested, such as the Triglyceride-Glucose (TyG) index and its variants, including the TyG-Body Mass Index (TyG-BMI), TyG-Waist Circumference (TyG-WC), and TyG-Waist-to-Height Ratio (TyG-WHtR). The aim of this study is to investigate the relationship between these TyG-related indices, which measure IR, and Obstructive Sleep Apnea (OSA). Methods This study analyzed NHANES data from 2007-2008, 2015-2016, and 2017-2020. TyG and its derivatives were evaluated as continuous and categorical variables in relation to OSA using multivariable logistic regression models. Subgroup analyses, dose-response relationships, and threshold effects were explored, and the diagnostic performance of TyG-related indices was assessed using AUC curves. Results The study included 8,374 participants. The fully adjusted Model 3 analysis (Note: Body Mass Index was not adjusted for TyG-BMI) of continuous variables showed a positive correlation between OSA and all four indices. All four TyG-related indicators showed statistically significant relationships with OSA when grouped into quartiles (TyG: AOR = 1.448, 95% CI: 1.260-1.663; TyG-BMI: AOR = 3.785, 95% CI: 3.319-4.317; TyG-WC: AOR = 2.089, 95% CI: 1.629-2.677; TyG-WHtR: AOR = 1.913, 95% CI: 1.548-2.363). Subgroup analysis revealed a stronger association of TyG-WHtR with OSA in the 41-59 age group (AOR = 1.459, 95% CI: 1.254-1.698) and the low-income group (AOR = 1.451, 95% CI: 1.241-1.698). TyG showed a linear relationship with OSA, while TyG-BMI, TyG-WC, and TyG-WHtR exhibited nonlinear relationships. The diagnostic capability was highest for TyG-WC, with an AUC of 0.647. Conclusion The study confirms strong associations between OSA and the TyG indices, particularly TyG-WC, which demonstrates significant predictive power for OSA risk. Future longitudinal studies are recommended to further investigate these associations and enhance OSA management in resource-constrained environments.
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Affiliation(s)
- Yating Zhou
- Kunshan Hospital of Traditional Chinese Medicine, Kunshan City, Suzhou, Jiangsu Province, People’s Republic of China
| | - Fei Xue
- Kunshan Hospital of Traditional Chinese Medicine, Kunshan City, Suzhou, Jiangsu Province, People’s Republic of China
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Ding L, Jiang X. The mediating effect of TyG and its derived indices in the association between OSAHS and atherosclerosis in patients with T2DM. Sleep Breath 2024; 28:2469-2479. [PMID: 39215937 DOI: 10.1007/s11325-024-03081-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/03/2024] [Accepted: 06/10/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE Triglyceride-glucose index (TyG) and its derived indices which better reflect metabolic disturbances on atherosclerosis has not been reliably compared in patients with type 2 diabetes mellitus (T2DM). Besides, obstructive sleep apnea hypopnea syndrome (OSAHS), a driver of atherosclerosis (AS), can exacerbate metabolic disturbances strongly. The aim of this study is to explore the mediating effect of glycolipid metabolism on the association between OSAHS and arterial stiffness in T2DM patients. METHODS 154 T2DM patients were involved in this study and were split into two groups: T2DM and T2DM + AS. Logistic regression analysis determined the accurate effects of different factors on the AS of T2DM patients. The capacity of TyG and the indices it derives to predict AS was assessed using the receiver operating characteristic (ROC) curve. Mediation analysis was employed to investigate the mediating effect of TyG and its derived indices on the association between OSAHS and arterial stiffness in T2DM patients. RESULTS OSAHS, TyG, and its derived indices were independent risk factors for AS in T2DM patients. Stratified by age, the hazardous effects of TyG and its derived indices remained significant in T2DM patients aged ≥ 50 years, but not in those aged < 50 years. In T2DM patients aged ≥ 50 years, the novel indices have a high predictive value for AS, with TyG-BMI exhibiting the largest AUC(AUC:0.788;95% CI:0.647 ∼ 0.928; P < 0.001). The mediation analysis results indicated that in T2DM patients aged ≥ 50 years, TyG, TyG-BMI, TyG-WC, and TyG-WHtR acted as potential mediators in the association between OSAHS and AS, with mediation effects of 33.42%, 48.2%, 37.7%, and 40.21%, respectively. However, there was no significant mediating effect observed in the younger patients. CONCLUSION TyG and its derived indices are strongly correlated with AS in T2DM patients, of which TyG-BMI has the best predictive performance. Besides, OSAHS partially exerts its atherogenic effect through glucolipid metabolism disorder in the T2DM population aged ≥ 50 years, while it mainly exerts a direct atherogenic effect in patients aged < 50 years.
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Affiliation(s)
- Ling Ding
- College of Medicine, Soochow University, Suzhou, China.
- Department of Endocrinology, The Third Affiliated Hospital of Soochow University, Changzhou, China.
| | - Xiaohong Jiang
- Department of Endocrinology, The Third Affiliated Hospital of Soochow University, Changzhou, China.
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Nayak SS, Kuriyakose D, Polisetty LD, Patil AA, Ameen D, Bonu R, Shetty SP, Biswas P, Ulrich MT, Letafatkar N, Habibi A, Keivanlou MH, Nobakht S, Alotaibi A, Hassanipour S, Amini-Salehi E. Diagnostic and prognostic value of triglyceride glucose index: a comprehensive evaluation of meta-analysis. Cardiovasc Diabetol 2024; 23:310. [PMID: 39180024 PMCID: PMC11344391 DOI: 10.1186/s12933-024-02392-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 08/05/2024] [Indexed: 08/26/2024] Open
Abstract
OBJECTIVE The present umbrella review aims to collate and summarize the findings from previous meta-analyses on the Triglyceride and Glucose (TyG) Index, providing insights to clinicians, researchers, and policymakers regarding the usefulness of this biomarker in various clinical settings. METHODS A comprehensive search was conducted in PubMed, Scopus, and Web of Science up to April 14, 2024, without language restrictions. The AMSTAR2 checklist assessed the methodological quality of the included meta-analyses. Statistical analyses were performed using Comprehensive Meta-Analysis (CMA) software. RESULTS A total of 32 studies were finally included. The results revealed significant associations between the TyG index and various health outcomes. For kidney outcomes, a high TyG index was significantly associated with an increased risk of contrast-induced nephropathy (CIN) (OR = 2.24, 95% CI: 1.82-2.77) and chronic kidney disease (CKD) (RR = 1.46, 95% CI: 1.32-1.63). High TyG index was significantly associated with an increased risk of type 2 diabetes mellitus (T2DM) (RR = 3.53, 95% CI: 2.74-4.54), gestational diabetes mellitus (GDM) (OR = 2.41, 95% CI: 1.48-3.91), and diabetic retinopathy (DR) (OR = 2.34, 95% CI: 1.31-4.19). Regarding metabolic diseases, the TyG index was significantly higher in patients with obstructive sleep apnea (OSA) (SMD = 0.86, 95% CI: 0.57-1.15), metabolic syndrome (MD = 0.83, 95% CI: 0.74-0.93), and non-alcoholic fatty liver disease (NAFLD) (OR = 2.36, 95% CI: 1.88-2.97) compared to those without these conditions. In cerebrovascular diseases, a higher TyG index was significantly associated with an increased risk of dementia (OR = 1.14, 95% CI: 1.12-1.16), cognitive impairment (OR = 2.31, 95% CI: 1.38-3.86), and ischemic stroke (OR = 1.37, 95% CI: 1.22-1.54). For cardiovascular outcomes, the TyG index showed significant associations with an increased risk of heart failure (HF) (HR = 1.21, 95% CI: 1.12-1.30), atrial fibrillation (AF) (SMD = 1.22, 95% CI: 0.57-1.87), and hypertension (HTN) (RR = 1.52, 95% CI: 1.25-1.85). CONCLUSION The TyG index is a promising biomarker for screening and predicting various medical conditions, particularly those related to insulin resistance and metabolic disorders. However, the heterogeneity and methodological quality of the included studies suggest the need for further high-quality research to confirm these findings and refine the clinical utility of the TyG index.
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Affiliation(s)
- Sandeep Samethadka Nayak
- Division of Hospital Medicine, Department of Internal Medicine, Bridgeport Hospital, Yale New Heaven, Bridgeport, CT, USA
| | - Dona Kuriyakose
- St. Joseph's Mission Hospital, Kollam District, Anchal, Kerala, India
| | - Lakshmi D Polisetty
- Division of Hospital Medicine, Department of Internal Medicine, Bridgeport Hospital, Yale New Heaven, Bridgeport, CT, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, John Dempsey Hospital, University of Connecticut, Bridgeport, CT, USA
| | - Anjali Avinash Patil
- Rajarshee Chhatrapati Shahu Maharaj Government Medical College Kolhapur Shenda park, Kolhapur, Maharashtra, India
| | - Daniyal Ameen
- Division of Hospital Medicine, Department of Internal Medicine, Bridgeport Hospital, Yale New Heaven, Bridgeport, CT, USA
| | - Rakshita Bonu
- Vydehi Institute of Medical Sciences and Research Centre, Bengaluru. 82, Nallurahalli Main Road, Whitefield, Bengaluru, Karnataka, India
| | - Samatha P Shetty
- Director of Capacity Management, NYC Health Hospitals, Elmhurst, USA
| | - Pubali Biswas
- Vydehi Institute of Medical Sciences and Research Centre, Bengaluru. 82, Nallurahalli Main Road, Whitefield, Bengaluru, Karnataka, India
| | - Micheal T Ulrich
- Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | | | - Arman Habibi
- Guilan University of Medical Sciences, Rasht, Iran
| | | | - Sara Nobakht
- Guilan University of Medical Sciences, Rasht, Iran
| | | | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, P.O. Box: 41448-95655, Rasht, Iran
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Cai Y, Chen J, Deng X, Wang B, Huang J, Lian N, Lian N. Triglyceride-glucose index and combined indicators: effective indicators for screening NAFLD in snoring patients. BMC Pulm Med 2024; 24:359. [PMID: 39049008 PMCID: PMC11270774 DOI: 10.1186/s12890-024-03166-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/12/2024] [Indexed: 07/27/2024] Open
Abstract
AIMS Nonalcoholic fatty liver disease (NAFLD) is a common complication in snoring patients, especially in patients with obstructive sleep apnea syndrome (OSA). Triglyceride-glucose (TyG) index was a simple indicator of metabolic status and a surrogate marker of insulin resistance. This study aimed to explore the relationship between NAFLD and TyG index in snoring patients. METHODS A retrospective study was conducted. The successive snoring patients enrolled in the Sleep Center of the First Affiliated Hospital of Fujian Medical University and had abdominal ultrasonography were included. The clinical characteristics of patients in different quartile TyG groups were compared. The relationship of the TyG index and NAFLD were valued via logistic regression models and restricted cubic spline analysis. The value of TyG index in predicting NAFLD was determined by receiver operating characteristic curve (ROC curve). RESULTS A total of 463 NAFLD cases were found among the 654 snoring patients. TyG index was a risk factor of NAFLD in snoring patients (OR = 2.38, 95% CI = 1.71-3.36). The risk of NAFLD was much higher in patients with the highest quartile of TyG index (OR = 5.12, 95% CI = 2.85-9.22), compared with the lowest quartile group. Restricted cubic spline (RCS) analysis showed a significant dose-response relationship between TyG index and risk of NAFLD (p for non-linearity < 0.001). A combination of TyG, neck circumference and ESS score presented the acceptable AUC for the detection of NAFLD in snoring patients (0.746, 95% CI 0.701-0.790, p < 0.001). CONCLUSION The TyG index was a risk factor of NAFLD in snoring patients. A combination of TyG, neck circumferences and ESS score could act as a convenient and effective indicator for screening NAFLD in snoring patients.
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Affiliation(s)
- Yuqing Cai
- Department of Respiratory and Critical Care Medicine, Respiratory Disease Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Respiratory and Critical Care Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Jia Chen
- Department of Respiratory and Critical Care Medicine, Respiratory Disease Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Respiratory and Critical Care Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Xiaoyu Deng
- Department of Respiratory and Critical Care Medicine, Respiratory Disease Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Respiratory and Critical Care Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Biying Wang
- Department of Respiratory and Critical Care Medicine, Respiratory Disease Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Respiratory and Critical Care Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Jiefeng Huang
- Department of Respiratory and Critical Care Medicine, Respiratory Disease Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Respiratory and Critical Care Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Ningfang Lian
- Department of Respiratory and Critical Care Medicine, Respiratory Disease Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Respiratory and Critical Care Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Ningfang Lian
- Department of Respiratory and Critical Care Medicine, Respiratory Disease Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
- Department of Respiratory and Critical Care Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
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Adeva-Andany MM, Domínguez-Montero A, Castro-Quintela E, Funcasta-Calderón R, Fernández-Fernández C. Hypoxia-Induced Insulin Resistance Mediates the Elevated Cardiovascular Risk in Patients with Obstructive Sleep Apnea: A Comprehensive Review. Rev Cardiovasc Med 2024; 25:231. [PMID: 39076340 PMCID: PMC11270082 DOI: 10.31083/j.rcm2506231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/07/2024] [Accepted: 04/12/2024] [Indexed: 07/31/2024] Open
Abstract
Patients with obstructive sleep apnea (OSA) experience insulin resistance and its clinical consequences, including hypertriglyceridemia, reduced high density lipoprotein-associated cholesterol (HDL-c), visceral adiposity, hepatic steatosis, increased epicardial fat thickness, essential hypertension, glucose intolerance, increased risk for type 2 diabetes, chronic kidney disease, subclinical vascular damage, and increased risk for cardiovascular events. Obesity is a major contributor to OSA. The prevalence of OSA is almost universal among patients with severe obesity undergoing bariatric surgery. However, insulin resistance and its clinical complications occur in OSA patients irrespective of general obesity (body mass index). In OSA patients, apnea episodes during sleep induce oxyhemoglobin desaturation and tissue hypoxia. Insulin resistance is an adaptive response to tissue hypoxia and develops in conditions with limited tissue oxygen supply, including healthy subjects exposed to hypobaric hypoxia (high altitude) and OSA patients. Indicators of oxyhemoglobin desaturation have been robustly and independently linked to insulin resistance and its clinical manifestations in patients with OSA. Insulin resistance mediates the elevated rate of type 2 diabetes, chronic kidney disease, and cardiovascular disease unexplained with traditional cardiovascular risk factors present in OSA patients. Pathophysiological processes underlying hypoxia-induced insulin resistance involve hypoxia inducible factor-1 upregulation and peroxisome proliferator-activated receptor-gamma (PPAR- γ ) downregulation. In human adipose tissue, PPAR- γ activity promotes glucose transport into adipocytes, lipid droplet biogenesis, and whole-body insulin sensitivity. Silencing of PPAR- γ in the adipose tissue reduces glucose uptake and fat accumulation into adipocytes and promotes insulin resistance. In conclusion, tissue hypoxia drives insulin resistance and its clinical consequences in patients with OSA, regardless of body mass index.
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Zhang S, Liu Y, Liu F, Ye Q, Guo D, Xu P, Wei T, Zhang C, Lu H. Correlation between the triglyceride-glucose index and left ventricular global longitudinal strain in patients with chronic heart failure: a cross-sectional study. Cardiovasc Diabetol 2024; 23:182. [PMID: 38811950 PMCID: PMC11137911 DOI: 10.1186/s12933-024-02259-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/01/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Left ventricular global longitudinal strain (GLS) holds greater diagnostic and prognostic value than left ventricular ejection fraction (LVEF) in the heart failure (HF) patients. The triglyceride-glucose (TyG) index serves as a reliable surrogate for insulin resistance (IR) and is strongly associated with several adverse cardiovascular events. However, there remains a research gap concerning the correlation between the TyG index and GLS among patients with chronic heart failure (CHF). METHOD 427 CHF patients were included in the final analysis. Patient demographic information, along with laboratory tests such as blood glucose, lipids profiles, and echocardiographic data were collected. The TyG index was calculated as Ln [fasting triglyceride (TG) (mg/dL) × fasting plasma glucose (FPG) (mg/dL)/2]. RESULTS Among CHF patients, GLS was notably lower in the higher TyG index group compared to the lower TyG index group. Following adjustment for confounding factors, GLS demonstrated gradual decrease with increasing TyG index, regardless of the LVEF level and CHF classification. CONCLUSION Elevated TyG index may be independently associated with more severe clinical left ventricular dysfunction in patients with CHF.
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Affiliation(s)
- Shuai Zhang
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, China
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Yan Liu
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, China
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Fangfang Liu
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, China
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Qing Ye
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, China
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Dachuan Guo
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, China
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Panpan Xu
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, China
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Tianhao Wei
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, China
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Cheng Zhang
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China.
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, China.
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China.
| | - Huixia Lu
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China.
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, China.
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China.
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Zhou T, Wang Y, Xu Y, Xu L, Tang L, Yang Y, Wang J. Multimodal data integration for enhanced longitudinal prediction for cardiac and cerebrovascular events following initial diagnosis of obstructive sleep apnea syndrome. J Glob Health 2024; 14:04103. [PMID: 38757902 PMCID: PMC11100360 DOI: 10.7189/jgh.14.04103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Background Obstructive sleep apnea syndrome (OSAS), a prevalent condition, often coexists with intricate metabolic issues and is frequently associated with negative cardiovascular outcomes. We developed a longitudinal prediction model integrating multimodal data for cardiovascular risk stratification of patients with an initial diagnosis of OSAS. Methods We reviewed the data of patients with new-onset OSAS who underwent diagnostic polysomnography between 2018-19. Patients were treated using standard treatment regimens according to clinical practice guidelines. Results Over a median follow-up of 32 months, 98/729 participants (13.4%) experienced our composite outcome. At a ratio of 7:3, cases were randomly divided into development (n = 510) and validation (n = 219) cohorts. A prediction nomogram was created using six clinical factors - sex, age, diabetes mellitus, history of coronary artery disease, triglyceride-glucose index, and apnea-hypopnea index. The prediction nomogram showed excellent discriminatory power, based on Harrell's C-index values of 0.826 (95% confidence interval (CI) = 0.779-0.873) for the development cohort and 0.877 (95% CI = 0.824-0.93) for the validation cohort. Moreover, comparing the predicted and observed major adverse cardiac and cerebrovascular events in both development and validation cohorts indicated that the prediction nomogram was well-calibrated. Decision curve analysis demonstrated the good clinical applicability of the prediction nomogram. Conclusions Our findings demonstrated the construction of an innovative visualisation tool that utilises various types of data to predict poor outcomes in Chinese patients diagnosed with OSAS, providing accurate and personalised therapy. Registration Chinese Clinical Trial Registry ChiCTR2300075727.
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Affiliation(s)
- Tong Zhou
- Department of Cardiology, First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Yijun Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yanan Xu
- Pulmonary and Critical Care Medicine, First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Li Xu
- Department of Cardiology, Guiqian International General Hospital, Guiyang, China
| | - Long Tang
- Department of Cardiology, People's Hospital of Xuancheng City, Affiliated Xuancheng Hospital of Wannan Medical College, Xuancheng, China
| | - Yi Yang
- Department of Cardiology, Xinjiang Medical University, Urumqi, China
- Department of Cardiology Fourth Ward, Xinjiang Medical University Affiliated Hospital of Traditional Chinese Medicine, Urumqi, China
| | - Jun Wang
- Department of Cardiology, First Affiliated Hospital of Bengbu Medical University, Bengbu, China
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Wang C, Shi M, Lin C, Wang J, Xie L, Li Y. Association between the triglyceride glucose index and obstructive sleep apnea and its symptoms: results from the NHANES. Lipids Health Dis 2024; 23:133. [PMID: 38705980 PMCID: PMC11071203 DOI: 10.1186/s12944-024-02125-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Certain studies have indicated a link between obstructive sleep apnea and insulin resistance in specific populations. To gain more clarity, extensive research involving a broad sample of the overall population is essential. The primary objective of this study was to investigate this correlation by utilizing data from the National Health and Nutrition Examination Survey database. METHODS The analysis incorporated data from the National Health and Nutrition Examination Survey database spanning the time periods from 2005 to 2008 and from 2015 to 2018, with a focus on American adults aged 18 years and older after applying weight adjustments. Key variables such as obstructive sleep apnea, triglyceride glucose index, and various confounding factors were considered. A generalized linear logistic regression model was used to investigate the association between obstructive sleep apnea and the triglyceride glucose index, with additional exploration of the consistency of the results through hierarchical analysis and other techniques. RESULTS The study included participants aged between 18 and 90 years, with an average age of 46.75 years. Among the total sample, 50.76% were male. The triglyceride glucose index demonstrated a diagnostic capability for obstructive sleep apnea, with an AUC of 0.701 (95% CI: 0.6619-0.688). According to the fully adjusted model, individuals in the fourth quartile of the triglyceride glucose index showed an increased likelihood of having obstructive sleep apnea compared to those in the first quartile (OR: 1.45; 95% CI: 1.02-2.06; P < 0.05). Subgroup analysis indicated that male sex (OR: 2.09; 95% CI: 1.76-2.45; P < 0.05), younger age (OR: 2.83; 95% CI: 2.02-3.96; P < 0.05), white ethnicity (OR: 2.29; 95% CI: 1.93-2.73; P < 0.05), and obesity (OR: 1.54; 95% CI: 1.28-1.85; P < 0.05) were correlated with an elevated risk of OSA. CONCLUSIONS This study demonstrated a strong association between an elevated TG index and OSA. Additionally, the triglyceride glucose index could serve as an independent predictor of obstructive sleep apnea.
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Affiliation(s)
- Chao Wang
- Heilongjiang University of Traditional Chinese Medicine, Harbin, 150006, China
| | - Mengdi Shi
- Heilongjiang University of Traditional Chinese Medicine, Harbin, 150006, China
| | - Chunsheng Lin
- The Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, 150001, China
| | - Jingyi Wang
- The First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, 150040, China
| | - Liangzhen Xie
- The First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, 150040, China.
| | - Yan Li
- The First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, 150040, China.
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12
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Huang J, Zhuang J, Zheng H, Yao L, Chen Q, Wang J, Fan C. A Machine Learning Prediction Model of Adult Obstructive Sleep Apnea Based on Systematically Evaluated Common Clinical Biochemical Indicators. Nat Sci Sleep 2024; 16:413-428. [PMID: 38699466 PMCID: PMC11063111 DOI: 10.2147/nss.s453794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/10/2024] [Indexed: 05/05/2024] Open
Abstract
Objective Obstructive sleep apnea (OSA) is a common and potentially fatal sleep disorder. The purpose of this study was to construct an objective and easy-to-promote model based on common clinical biochemical indicators and demographic data for OSA screening. Methods The study collected the clinical data of patients who were referred to the Sleep Medicine Center of the Second Affiliated Hospital of Fujian Medical University from December 1, 2020, to July 31, 2023, including data for demographics, polysomnography (PSG), and 30 biochemical indicators. Univariate and multivariate analyses were performed to compare the differences between groups, and the Boruta method was used to analyze the importance of the predictors. We selected and compared 10 predictors using 4 machine learning algorithms which were "Gaussian Naive Bayes (GNB)", "Support Vector Machine (SVM)", "K Neighbors Classifier (KNN)", and "Logistic Regression (LR)". Finally, the optimal algorithm was selected to construct the final prediction model. Results Among all the predictors of OSA, body mass index (BMI) showed the best predictive efficacy with an area under the receiver operating characteristic curve (AUC) = 0.699; among the predictors of biochemical indicators, triglyceride-glucose (TyG) index represented the best predictive performance (AUC = 0.656). The LR algorithm outperformed the 4 established machine learning (ML) algorithms, with an AUC (F1 score) of 0.794 (0.841), 0.777 (0.827), and 0.732 (0.788) in the training, validation, and testing cohorts, respectively. Conclusion We have constructed an efficient OSA screening tool. The introduction of biochemical indicators in ML-based prediction models can provide a reference for clinicians in determining whether patients with suspected OSA need PSG.
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Affiliation(s)
- Jiewei Huang
- The Clinical Laboratory Center of the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, 362018, People’s Republic of China
- The Graduate School of Fujian Medical University, Fuzhou, Fujian Province, 350108, People’s Republic of China
| | - Jiajing Zhuang
- The Graduate School of Fujian Medical University, Fuzhou, Fujian Province, 350108, People’s Republic of China
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, 350001, People’s Republic of China
| | - Huaxian Zheng
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian Province, 350108, People’s Republic of China
| | - Ling Yao
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350000, People’s Republic of China
- Department of Nephrology, Rheumatology and Immunology, Fujian Children’s Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350014, People’s Republic of China
| | - Qingquan Chen
- The Sleep Disorder Medicine Center of the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, 362018, People’s Republic of China
- The School of Public Health, Fujian Medical University, Fuzhou, Fujian Province, 350108, People’s Republic of China
| | - Jiaqi Wang
- The Clinical Laboratory Center of the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, 362018, People’s Republic of China
- The Graduate School of Fujian Medical University, Fuzhou, Fujian Province, 350108, People’s Republic of China
| | - Chunmei Fan
- The Clinical Laboratory Center of the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, 362018, People’s Republic of China
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Behnoush AH, Khalaji A, Ghondaghsaz E, Masrour M, Shokri Varniab Z, Khalaji S, Cannavo A. Triglyceride-glucose index and obstructive sleep apnea: a systematic review and meta-analysis. Lipids Health Dis 2024; 23:4. [PMID: 38185682 PMCID: PMC10773018 DOI: 10.1186/s12944-024-02005-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/01/2024] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) has a bidirectional association with metabolic syndrome, and insulin resistance (IR). The triglyceride-glucose (TyG) index could be a simply calculated marker of IR in OSA. However, its clinical application appears still limited. Hence, this systematic review and meta-analysis aimed to respond to this question by analyzing all the existing studies showing an association between OSA and the TyG index. METHODS Four online databases, including PubMed, Scopus, the Web of Science, and Embase were searched for studies evaluating the TyG index in OSA. After screening and data extraction, a random-effect meta-analysis was performed to compare the TyG index in OSA patients vs. healthy controls by calculating standardized mean difference (SMD) and 95% confidence interval (CI) and pooling the area under the curves (AUCs) for diagnosis of OSA based on this index. RESULTS Ten studies involving 16,726 individuals were included in the current systematic review. Meta-analysis indicated that there was a significantly higher TyG index in patients with OSA, compared with the healthy controls (SMD 0.856, 95% CI 0.579 to 1.132, P < 0.001). Also, TyG had a diagnostic ability for OSA representing a pooled AUC of 0.681 (95% CI 0.627 to 0.735). However, based on the two studies' findings, no difference between different severities of OSA was observed. Finally, our data showed that the TyG index is a good potential predictor of adverse outcomes in these patients. CONCLUSION Our study revealed that the TyG index is an easy-to-measure marker of IR for assessing OSA, both in diagnosis and prognosis. Our study supports its implementation in routine practice to help clinicians in decision-making and patient stratification.
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Affiliation(s)
- Amir Hossein Behnoush
- School of Medicine, Tehran University of Medical Sciences, Poursina St., Keshavarz Blvd, Tehran, 1417613151, Iran
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirmohammad Khalaji
- School of Medicine, Tehran University of Medical Sciences, Poursina St., Keshavarz Blvd, Tehran, 1417613151, Iran.
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Elina Ghondaghsaz
- Undergraduate Program in Neuroscience, University of British Columbia, Vancouver, BC, Canada
| | - Mahdi Masrour
- School of Medicine, Tehran University of Medical Sciences, Poursina St., Keshavarz Blvd, Tehran, 1417613151, Iran
| | - Zahra Shokri Varniab
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Khalaji
- School of Medicine, Tehran University of Medical Sciences, Poursina St., Keshavarz Blvd, Tehran, 1417613151, Iran
| | - Alessandro Cannavo
- Department of Translational Medicine Sciences, Federico II University of Naples, Naples, Italy
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Sökücü SN, Aydın Ş, Satıcı C, Tural Önür S, Özdemir C. Triglyceride-glucose index as a predictor of obstructive sleep apnoea severity in the absence of traditional risk factors. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:891-897. [PMID: 37939719 PMCID: PMC10631848 DOI: 10.1055/s-0043-1776411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/24/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE We evaluated the association between the triglyceride-glucose (TG) index, a marker of insulin resistance, and obstructive sleep apnoea (OSA) severity in patients without diabetes mellitus, obesity, and metabolic syndrome. METHODS This retrospective cohort study included 1,527 patients. We used univariate and multivariate analyses to identify the independent predictors associated with OSA. RESULTS Most patients were males (81.5%) with a mean age of 43.9 ± 11.1 (15-90) years. Based on the apnoea-hypopnea index (AHI), 353 (23.1%) patients were included in the control group, whereas 32.4%, 23.5%, and 21% had mild, moderate, and severe OSA, respectively. The TG index values demonstrated significant associations with OSA patients compared with the control group (p = 0.001). In addition, the mean values of the oxygen desaturation index (ODI), AHI, minimum oxygen saturation, and total sleep time percentage with saturation below 90% demonstrated statistically significant differences among the TG index groups (p: 0.001; p:0.001; p:0.001; p:0.003). The optimal TG index cutoff value to predict OSA was 8.615 (AUC = 0.638, 95% CI = 0.606-0.671, p = 0.001). In multivariate logistic regression analysis, after adjusting for age, sex, and body mass index, the TG index was independently associated with OSA patients. CONCLUSION The TG index is independently associated with increased risk for OSA. This indicates that this index, a marker for disease severity, can be used to identify severe OSA patients on waiting lists for PSG.
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Affiliation(s)
- Sinem Nedime Sökücü
- University of Health Sciences, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Sleep Laboratory, Istanbul, Turkey.
| | - Şenay Aydın
- University of Health Sciences, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Sleep Laboratory, Istanbul, Turkey.
| | - Celal Satıcı
- University of Health Sciences, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Sleep Laboratory, Istanbul, Turkey.
| | - Seda Tural Önür
- University of Health Sciences, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Sleep Laboratory, Istanbul, Turkey.
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Feng T, Shan G, He H, Pei G, Tan J, Lu B, Ou Q. The association of nocturnal hypoxemia with dyslipidemia in sleep-disordered breathing population of Chinese community: a cross-sectional study. Lipids Health Dis 2023; 22:159. [PMID: 37752495 DOI: 10.1186/s12944-023-01919-8if:] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/09/2023] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Currently, there is limited and controversial clinical research on the correlation between sleep-disordered breathing (SDB) and dyslipidemia. This discrepancy in findings may be because studies that primarily focused on hospital-based populations may not be applicable to community-based populations. Therefore, the primary objective of this research endeavor is to scrutinize the correlation between nocturnal hypoxemia and blood lipid concentrations among adult individuals residing in the community who exhibit symptoms of SDB. Additionally, this study aimed to identify the nocturnal hypoxia parameters having the strongest correlation with this relationship. METHODS This cross-sectional study collected data from The Guangdong Sleep Health Study, which included 3829 participants. Type IV sleep monitoring was employed to measure hypoxemia parameters, and lipoproteins were evaluated using fasting blood samples. To understand the association between dyslipidemia and hypoxemia parameters, a multivariable logistic regression model was used. Subgroup analyses were conducted to stratify data according to age, sex, waist circumference, and chronic diseases. RESULTS The age of the individuals involved in the study spanned from 20 to 90 years. The average age of the participants was 56.15 ± 13.11 years. Of the total sample size, 55.7% were male. In the fully adjusted model, the meanSpO2 was negatively associated with hyperlipidemia (0.9303 [95% confidence interval 0.8719, 0.9925]). Upon conducting a nonlinearity test, the relationship between the meanSpO2 and hyperlipidemia was nonlinear. The inflection points were determined to be 95. When meanSpO2 ≥ 95%, a difference of 1 in the meanSpO2 corresponded to a 0.07 difference in the risk of hyperlipidemia. CONCLUSIONS This study revealed that higher meanSpO2 is significantly and negatively associated with hyperlipidemia in adult community residents with SDB, particularly when the meanSpO2 exceeds 95. This finding emphasizes the importance of close monitoring for dyslipidemia, which is considered an early indicator of atherosclerosis in patients with SDB who experience nocturnal hypoxia.
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Affiliation(s)
- Tong Feng
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Sleep Center, Department of Respiratory and Critical Care MedicineGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Yuexiu District, Southern Medical University, No.106 Zhongshan Road, Guangzhou City, Guangdong Province, China
| | - Guangliang Shan
- Department of Epidemiology & Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences/School of Basic Medicine, Peking Union Medical College, Beijing, People's Republic of China
| | - Huijing He
- Department of Epidemiology & Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences/School of Basic Medicine, Peking Union Medical College, Beijing, People's Republic of China
| | - Guo Pei
- Sleep Center, Department of Respiratory and Critical Care MedicineGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Yuexiu District, Southern Medical University, No.106 Zhongshan Road, Guangzhou City, Guangdong Province, China
| | - Jiaoying Tan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Sleep Center, Department of Respiratory and Critical Care MedicineGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Yuexiu District, Southern Medical University, No.106 Zhongshan Road, Guangzhou City, Guangdong Province, China
| | - Bing Lu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Sleep Center, Department of Respiratory and Critical Care MedicineGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Yuexiu District, Southern Medical University, No.106 Zhongshan Road, Guangzhou City, Guangdong Province, China
| | - Qiong Ou
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
- Sleep Center, Department of Respiratory and Critical Care MedicineGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Yuexiu District, Southern Medical University, No.106 Zhongshan Road, Guangzhou City, Guangdong Province, China.
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Feng T, Shan G, He H, Pei G, Tan J, Lu B, Ou Q. The association of nocturnal hypoxemia with dyslipidemia in sleep-disordered breathing population of Chinese community: a cross-sectional study. Lipids Health Dis 2023; 22:159. [PMID: 37752495 PMCID: PMC10521560 DOI: 10.1186/s12944-023-01919-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/09/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Currently, there is limited and controversial clinical research on the correlation between sleep-disordered breathing (SDB) and dyslipidemia. This discrepancy in findings may be because studies that primarily focused on hospital-based populations may not be applicable to community-based populations. Therefore, the primary objective of this research endeavor is to scrutinize the correlation between nocturnal hypoxemia and blood lipid concentrations among adult individuals residing in the community who exhibit symptoms of SDB. Additionally, this study aimed to identify the nocturnal hypoxia parameters having the strongest correlation with this relationship. METHODS This cross-sectional study collected data from The Guangdong Sleep Health Study, which included 3829 participants. Type IV sleep monitoring was employed to measure hypoxemia parameters, and lipoproteins were evaluated using fasting blood samples. To understand the association between dyslipidemia and hypoxemia parameters, a multivariable logistic regression model was used. Subgroup analyses were conducted to stratify data according to age, sex, waist circumference, and chronic diseases. RESULTS The age of the individuals involved in the study spanned from 20 to 90 years. The average age of the participants was 56.15 ± 13.11 years. Of the total sample size, 55.7% were male. In the fully adjusted model, the meanSpO2 was negatively associated with hyperlipidemia (0.9303 [95% confidence interval 0.8719, 0.9925]). Upon conducting a nonlinearity test, the relationship between the meanSpO2 and hyperlipidemia was nonlinear. The inflection points were determined to be 95. When meanSpO2 ≥ 95%, a difference of 1 in the meanSpO2 corresponded to a 0.07 difference in the risk of hyperlipidemia. CONCLUSIONS This study revealed that higher meanSpO2 is significantly and negatively associated with hyperlipidemia in adult community residents with SDB, particularly when the meanSpO2 exceeds 95. This finding emphasizes the importance of close monitoring for dyslipidemia, which is considered an early indicator of atherosclerosis in patients with SDB who experience nocturnal hypoxia.
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Affiliation(s)
- Tong Feng
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Sleep Center, Department of Respiratory and Critical Care MedicineGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Yuexiu District, Southern Medical University, No.106 Zhongshan Road, Guangzhou City, Guangdong Province, China
| | - Guangliang Shan
- Department of Epidemiology & Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences/School of Basic Medicine, Peking Union Medical College, Beijing, People's Republic of China
| | - Huijing He
- Department of Epidemiology & Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences/School of Basic Medicine, Peking Union Medical College, Beijing, People's Republic of China
| | - Guo Pei
- Sleep Center, Department of Respiratory and Critical Care MedicineGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Yuexiu District, Southern Medical University, No.106 Zhongshan Road, Guangzhou City, Guangdong Province, China
| | - Jiaoying Tan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Sleep Center, Department of Respiratory and Critical Care MedicineGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Yuexiu District, Southern Medical University, No.106 Zhongshan Road, Guangzhou City, Guangdong Province, China
| | - Bing Lu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Sleep Center, Department of Respiratory and Critical Care MedicineGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Yuexiu District, Southern Medical University, No.106 Zhongshan Road, Guangzhou City, Guangdong Province, China
| | - Qiong Ou
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
- Sleep Center, Department of Respiratory and Critical Care MedicineGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Yuexiu District, Southern Medical University, No.106 Zhongshan Road, Guangzhou City, Guangdong Province, China.
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Basoglu OK, Tasbakan MS, Kayikcioglu M. Dyslipidemia prevalence in nonobese, nondiabetic patients with obstructive sleep apnea: does sex matter? J Clin Sleep Med 2023; 19:889-898. [PMID: 36708260 PMCID: PMC10152354 DOI: 10.5664/jcsm.10490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 01/29/2023]
Abstract
STUDY OBJECTIVES Dyslipidemia in obstructive sleep apnea (OSA) has been attributed to confounding obesity and/or diabetes. This study aimed to examine lipid profiles in nondiabetic, nonobese patients with OSA and identify the possible effects of age and sex. METHODS We retrospectively evaluated the lipid parameters of 3,050 adults who underwent polysomnography. A total of 2,168 patients were excluded due to obesity (body mass index ≥ 30 kg/m2), diabetes, alcoholism, untreated hypothyroidism, lipid-lowering drug use, missing sleep data, or treatment for suspected OSA. RESULTS Of 882 patients (75% males, aged 46.8 ± 12.2 years) included in the study, 88.4% had OSA. Levels of total cholesterol (P = .003), low-density-lipoprotein (LDL) cholesterol (P = .005), non-high-density-lipoprotein (non-HDL) cholesterol (P = .001), and triglycerides (P = .007) were significantly higher in patients with OSA than in those without, whereas HDL-cholesterol levels did not differ. The proportion of patients with hypercholesterolemia and/or elevated non-HDL cholesterol (> 160 mg/dL) was significantly higher in OSA than in non-OSA. Correlation analyses by sex revealed stronger and more significant relationships between lipid parameters and apnea-hypopnea index in women than in men (r = .135, P < .001, vs r = .080, P = .043 for total cholesterol; r = .111, P < .001, vs r = .080, P = .046 for non-HDL cholesterol; r = .122, P < .001, vs r = .061, P = .107 for LDL cholesterol, respectively). In regression analysis, the rate of hypercholesterolemia increased with age (P < .001 for women and P = .031 for men); non-HDL- and LDL-cholesterol levels significantly increased with OSA severity (P = .035 and P = .023, respectively) and age (P = .004 and P = .001, respectively) in women. CONCLUSIONS After excluding confounding obesity and diabetes, patients with OSA have an impaired lipid profile including total cholesterol, LDL cholesterol, non-HDL cholesterol, and triglycerides. A significant association between dyslipidemia and OSA severity was observed in women but not in men. CITATION Basoglu OK, Tasbakan MS, Kayikcioglu M. Dyslipidemia prevalence in nonobese, nondiabetic patients with obstructive sleep apnea: does sex matter? J Clin Sleep Med. 2023;19(5):889-898.
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Affiliation(s)
- Ozen K. Basoglu
- Department of Chest Diseases, Ege University Faculty of Medicine, Izmir, Turkey
| | | | - Meral Kayikcioglu
- Department of Cardiology, Ege University Faculty of Medicine, Izmir, Turkey
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Liu CF, Chien LW. Triglyceride glucose index and poor sleep patterns in non-diabetic adults: Evidence from NHANES 2005-2016. Front Nutr 2023; 10:1051667. [PMID: 36793924 PMCID: PMC9922746 DOI: 10.3389/fnut.2023.1051667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/06/2023] [Indexed: 02/02/2023] Open
Abstract
Introduction Sleep disorders are commonly encountered in modern populations. This cross-sectional study aimed to investigate the associations between triglyceride glucose (TyG) index and poor sleep patterns in non-diabetic adults. Methods Data of non-diabetic adults aged 20-70 years were extracted from the US National Health and Nutrition Examination Survey database 2005-2016. Pregnant women, individuals with diabetes and cancer history, and individuals lacking complete data on sleep patterns or parameters for calculating TyG index were excluded. Poor sleep pattern was defined as having two or more following conditions: (1) abnormal sleep duration, defined as less than 7 h or longer than 9 h; (2) self-reported trouble sleeping; and (3) physician-confirmed sleep disorders. Associations between poor sleep patterns, TyG index, and an additional index incorporating body mass index (BMI), TyGBMI, and other study variables were determined by univariable and multivariable logistic regression analysis. Results Among 9,390 included participants, 1,422 had poor sleep patterns and 7,968 did not. The individuals with poor sleep patterns had a higher mean TyG index, were older, had higher BMI, and had higher proportions of hypertension and history of CVD than those without poor sleep pattern (all p < 0.001). Multivariable analysis showed no significant association between poor sleep pattern and TyG index. However, among the components of poor sleep pattern, TyG index in the highest quartile (Q4) was significantly associated with trouble sleeping [adjusted OR (aOR): 1.46, 95%CI: 1.04-2.03) as compared with the lowest TyG quartile (Q1). In addition, TyG-BMI in Q4 was indepently associated with increased likelihood for poor sleep patterns (aOR: 2.18, 95%CI: 1.61-2.95), trouble sleeping (aOR: 1.76, 95%CI: 1.30-2.39), abnormal sleep duration (aOR: 1.41, 95%CI: 1.12-1.78), and sleep disorders (aOR: 3.11, 95%CI: 2.08-4.64) as compared to Q1. Discussion Among US adults without diabetes, elevated TyG index is correlated with self-reported trouble sleeping, independent of BMI. Future studies should build upon this preliminary work and examine these associations longitudinally and through treatment trials.
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Affiliation(s)
- Chi-Feng Liu
- School of Nursing, National Taipei University of Nursing and Health Science, Taipei, Taiwan,*Correspondence: Chi-Feng Liu,
| | - Li-Wei Chien
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan,Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
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19
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Avelino DC, da Silva A, Chaves LO, Carraro JCC, de Carvalho Vidigal F, Bressan J. Triglyceride-glucose index is associated with poor sleep quality in apparently healthy subjects: A cross-sectional study. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 67:73-91. [PMID: 36155123 PMCID: PMC9983794 DOI: 10.20945/2359-3997000000517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective We aimed to evaluate the association between the triglyceride glucose index (TyG index) and sleep quality and to establish a cut-off value for the TyG index based on the prevalence of subjects with insulin resistance (IR). Methods This cross-sectional study involved Brazilian health professionals (20-59 years). A total of 138 subjects answered the Pittsburgh Sleep Quality questionnaire to evaluate sleep quality. They were categorized into two groups: good sleep quality (global score ≤ 5 points) and poor sleep quality (global score ≥ 6 points). Also, we classified the subjects as having a high (>8.08 or >4.38) or low TyG index (≤ 8.08 or ≤4.38). Results The majority of the subjects (70%) with high TyG index values (>8.08 or >4.38) reported poor sleep quality (p ≤ 0.001). Those with poor sleep quality had a 1.44-fold higher prevalence of IR (TyG index >8.08 or >4.38) compared to those with good sleep quality, regardless of sex, total cholesterol, LDL/HDL ratio, insulin, complement C3, CRP, and adiponectin (p ≤ 0.001). Conclusion Our data showed a positive and significant association between the TyG index and poor sleep quality. Thus, these findings support the association between poor sleep quality and IR.
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Affiliation(s)
| | - Alessandra da Silva
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa, Viçosa, MG, Brasil
| | | | | | | | - Josefina Bressan
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa, Viçosa, MG, Brasil
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Huang L, Long Z, Xu G, Chen Y, Li R, Wang Y, Li S. Sex-specific association of sleep duration with subclinical indicators of metabolic diseases among asymptomatic adults. Lipids Health Dis 2022; 21:16. [PMID: 35067221 PMCID: PMC8783994 DOI: 10.1186/s12944-022-01626-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background Accumulating evidence suggests sleep duration may be involved in metabolic regulation. However, studies regarding the association with the early stage of the metabolic disease are limited, and the findings were inconsistent. Methods A study among 4922 asymptomatic adults was conducted based on a Chinese national survey in 2009. The early stage of metabolic diseases was evaluated using three proxies: triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C), the product of triglyceride and fasting glucose (TyG), and lipid accumulation product (LAP). Multivariable linear and logistic regression models were used to explore the associations of sleep duration with the three indicators. Results The linear regression models revealed that, among females, sleep duration <7 h per day, compared with 7-9 h, was associated with an increased value of LAP and TyG by 25.232% (95%CI: 10.738%, 41.623%) and 0.104 (95%CI: 0.024, 0.185), respectively, in the crude model. The effects were attenuated but remained significant for LAP (11.405%; 95%CI: 1.613%, 22.262%). Similarly, the logistic regression models further found that sleep duration <7 h per day could increase the risk of elevated LAP (OR: 1.725, 95CI%:1.042, 2.856) after adjusting for multiple covariates. By contrast, no associations were found among males. Conclusions Short sleep duration was associated with subclinical indicators of metabolic diseases, and females were more susceptible to the association. Supplementary Information The online version contains supplementary material available at 10.1186/s12944-022-01626-w.
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Affiliation(s)
- Lili Huang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, 200025, Shanghai, China
| | - Zichong Long
- School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, 200025, Shanghai, China
| | - Gang Xu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, 200025, Shanghai, China
| | - Yiting Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, 200025, Shanghai, China
| | - Rong Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, 200025, Shanghai, China
| | - Yanlin Wang
- International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, 910 Hengshan Road, 200030, Shanghai, China.
| | - Shenghui Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, 200025, Shanghai, China. .,MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, 200092, Shanghai, China.
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Lian N, Wu J, Wang B, Lin S, Huang J, Chen J, Lin Q. Risk Factors of Nonalcoholic Fatty Liver Disease and Liver Fibrosis in Non-Obese Patients with Obstructive Sleep Apnea. Nat Sci Sleep 2022; 14:2143-2149. [PMID: 36507312 PMCID: PMC9733560 DOI: 10.2147/nss.s388203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/24/2022] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Liver injury in non-obese obstructive sleep apnea (OSA) patients has received much attention in recent years. This study aimed to investigate risk factors of nonalcoholic fatty liver disease (NAFLD) and liver fibrosis in non-obese patients with OSA. METHODS A retrospective study was conducted in the Sleep Center of the First Affiliated Hospital of Fujian Medical University. All consecutive non-obese patients with suspected sleep apnea admitted to the center were enrolled. The clinical characteristics of patients with simple snoring and with different severity OSA were compared. Multivariate logistic regression models were used to analyze the risk factors of NAFLD and liver fibrosis. RESULTS A total of 410 patients were enrolled. The levels of triglyceride, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) increased with the aggravation of OSA (All p<0.05). Among non-obese patients with OSA, 17 (5%) were diagnosed with liver fibrosis and 228 (65%) with NAFLD; Apnea‑hyponea index (AHI) was an independent predictor for NAFLD and liver fibrosis [OR (95% CI): 1.02 (1.00-1.03), 1.04 (1.00-1.07), both p<0.05]; hypertriglyceridemia was an independent predictor for NAFLD [OR (95% CI): 1.13 (1.12-1.99), p<0.05]. CONCLUSION NAFLD and liver fibrosis were common in non-obese OSA patients and the severity of OSA was an independent risk factor for them.
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Affiliation(s)
- Ningfang Lian
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University; Fujian Provincial Sleep-Disordered Breathing Clinic Center; National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University; Institute of Respiratory Disease, Fujian Medical University, Fuzhou, People's Republic of China
| | - Jiawei Wu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University; Fujian Provincial Sleep-Disordered Breathing Clinic Center; National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University; Institute of Respiratory Disease, Fujian Medical University, Fuzhou, People's Republic of China
| | - Biying Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University; Fujian Provincial Sleep-Disordered Breathing Clinic Center; National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University; Institute of Respiratory Disease, Fujian Medical University, Fuzhou, People's Republic of China
| | - Su Lin
- Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Jiefeng Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University; Fujian Provincial Sleep-Disordered Breathing Clinic Center; National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University; Institute of Respiratory Disease, Fujian Medical University, Fuzhou, People's Republic of China
| | - Jia Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University; Fujian Provincial Sleep-Disordered Breathing Clinic Center; National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University; Institute of Respiratory Disease, Fujian Medical University, Fuzhou, People's Republic of China
| | - Qichang Lin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University; Fujian Provincial Sleep-Disordered Breathing Clinic Center; National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University; Institute of Respiratory Disease, Fujian Medical University, Fuzhou, People's Republic of China
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Hu J, Cai X, Li N, Zhu Q, Wen W, Hong J, Zhang D, Yao X, Luo Q, Sun L. Association Between Triglyceride Glucose Index-Waist Circumference and Risk of First Myocardial Infarction in Chinese Hypertensive Patients with Obstructive Sleep Apnoea: An Observational Cohort Study. Nat Sci Sleep 2022; 14:969-980. [PMID: 35615442 PMCID: PMC9126228 DOI: 10.2147/nss.s362101] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/06/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study aimed to investigate the association between triglyceride glucose index-waist circumference (TyG-WC) and the risk of first myocardial infarction (MI) in Chinese hypertensive patients with obstructive sleep apnoea (OSA). METHODS This study was an observational cohort study. A total of 2224 Chinese hypertensive patients with OSA without a history of MI were included in this study. Hazard ratio (HR) and 95% confidence interval (CI) were estimated using multivariable Cox proportion hazard models. A generalized additive model was used to identify nonlinear relationships. Additionally, we performed hierarchical analysis and test for interaction. RESULTS During a median follow-up of 7.15 years, 85 incidents of MI developed. Overall, there was a positive association between TyG-WC and the risk of first MI. In the multivariable-adjusted model, the risk of MI increased with quartiles of the TyG-WC, the HR in quartile 4 versus quartile 1 was 4.29. A generalized additive model and a smooth curve fitting showed that there existed a similar J-shaped association between TyG-WC and the risk of first MI, with an inflection point at about 785. CONCLUSION Elevated levels of the baseline TyG-WC are associated with an increased risk of first MI. This finding indicates that the TyG-WC might be useful to identify the high risk of first MI in Chinese hypertensive patients with OSA.
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Affiliation(s)
- Junli Hu
- Hypertension Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Hypertension Institute, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,National Health Committee Key Laboratory of Hypertension Clinical Research, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Key Laboratory of Xinjiang Uygur Autonomous Region, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Clinical Medical Research Center for Hypertension Diseases, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China
| | - Xintian Cai
- Hypertension Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Hypertension Institute, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,National Health Committee Key Laboratory of Hypertension Clinical Research, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Key Laboratory of Xinjiang Uygur Autonomous Region, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Clinical Medical Research Center for Hypertension Diseases, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China
| | - Nanfang Li
- Hypertension Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Hypertension Institute, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,National Health Committee Key Laboratory of Hypertension Clinical Research, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Key Laboratory of Xinjiang Uygur Autonomous Region, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Clinical Medical Research Center for Hypertension Diseases, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China
| | - Qing Zhu
- Hypertension Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Hypertension Institute, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,National Health Committee Key Laboratory of Hypertension Clinical Research, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Key Laboratory of Xinjiang Uygur Autonomous Region, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Clinical Medical Research Center for Hypertension Diseases, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China
| | - Wen Wen
- Hypertension Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Hypertension Institute, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,National Health Committee Key Laboratory of Hypertension Clinical Research, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Key Laboratory of Xinjiang Uygur Autonomous Region, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Clinical Medical Research Center for Hypertension Diseases, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China
| | - Jing Hong
- Hypertension Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Hypertension Institute, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,National Health Committee Key Laboratory of Hypertension Clinical Research, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Key Laboratory of Xinjiang Uygur Autonomous Region, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Clinical Medical Research Center for Hypertension Diseases, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China
| | - Delian Zhang
- Hypertension Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Hypertension Institute, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,National Health Committee Key Laboratory of Hypertension Clinical Research, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Key Laboratory of Xinjiang Uygur Autonomous Region, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Clinical Medical Research Center for Hypertension Diseases, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China
| | - Xiaoguang Yao
- Hypertension Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Hypertension Institute, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,National Health Committee Key Laboratory of Hypertension Clinical Research, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Key Laboratory of Xinjiang Uygur Autonomous Region, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Clinical Medical Research Center for Hypertension Diseases, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China
| | - Qin Luo
- Hypertension Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China
| | - Le Sun
- Hypertension Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Hypertension Institute, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,National Health Committee Key Laboratory of Hypertension Clinical Research, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Key Laboratory of Xinjiang Uygur Autonomous Region, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.,Xinjiang Clinical Medical Research Center for Hypertension Diseases, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China
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Gómez-Sánchez L, Gómez-Sánchez M, Lugones-Sánchez C, Tamayo-Morales O, González-Sánchez S, Rodríguez-Sánchez E, García-Ortiz L, Gómez-Marcos MA. Association of Insulin Resistance with Vascular Ageing in a General Caucasian Population: An EVA Study. J Clin Med 2021; 10:jcm10245748. [PMID: 34945044 PMCID: PMC8707603 DOI: 10.3390/jcm10245748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
The data on the relationship between insulin resistance and vascular ageing are limited. The aim of this study was to explore the association of different indices of insulin resistance with vascular ageing in an adult Caucasian population without cardiovascular disease. We selected 501 individuals without cardiovascular disease (mean age: 55.9 years, 50.3% women) through random sampling stratified by sex and age. Arterial stiffness was evaluated by measuring the carotid-to-femoral pulse wave velocity (cfPWV) and brachial-to-ankle pulse wave velocity (baPWV). The participants were classified into three groups according to the degree of vascular ageing: early vascular ageing (EVA), normal vascular ageing (NVA) and healthy vascular ageing (HVA). Insulin resistance was evaluated with the homeostatic model assessment of insulin resistance (HOMA-IR) and another five indices. The prevalence of HVA and EVA was 8.4% and 21.4%, respectively, when using cfPWV, and 7.4% and 19.2%, respectively, when using baPWV. The deterioration of vascular ageing, with both measurements, presented as an increase in all the analysed indices of insulin resistance. In the multiple regression analysis and logistic regression analysis, the indices of insulin resistance showed a positive association with cfPWV and baPWV and with EVA.
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Affiliation(s)
- Leticia Gómez-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (L.G.-S.); (M.G.-S.); (C.L.-S.); (O.T.-M.); (S.G.-S.); (E.R.-S.); (L.G.-O.)
- Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain
| | - Marta Gómez-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (L.G.-S.); (M.G.-S.); (C.L.-S.); (O.T.-M.); (S.G.-S.); (E.R.-S.); (L.G.-O.)
- Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain
| | - Cristina Lugones-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (L.G.-S.); (M.G.-S.); (C.L.-S.); (O.T.-M.); (S.G.-S.); (E.R.-S.); (L.G.-O.)
- Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain
| | - Olaya Tamayo-Morales
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (L.G.-S.); (M.G.-S.); (C.L.-S.); (O.T.-M.); (S.G.-S.); (E.R.-S.); (L.G.-O.)
- Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain
| | - Susana González-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (L.G.-S.); (M.G.-S.); (C.L.-S.); (O.T.-M.); (S.G.-S.); (E.R.-S.); (L.G.-O.)
- Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain
| | - Emiliano Rodríguez-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (L.G.-S.); (M.G.-S.); (C.L.-S.); (O.T.-M.); (S.G.-S.); (E.R.-S.); (L.G.-O.)
- Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain
- Health Service of Castile and Leon (SACyL), 37007 Salamanca, Spain
- Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain
| | - Luis García-Ortiz
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (L.G.-S.); (M.G.-S.); (C.L.-S.); (O.T.-M.); (S.G.-S.); (E.R.-S.); (L.G.-O.)
- Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain
- Health Service of Castile and Leon (SACyL), 37007 Salamanca, Spain
- Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain
| | - Manuel A. Gómez-Marcos
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (L.G.-S.); (M.G.-S.); (C.L.-S.); (O.T.-M.); (S.G.-S.); (E.R.-S.); (L.G.-O.)
- Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain
- Health Service of Castile and Leon (SACyL), 37007 Salamanca, Spain
- Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain
- Correspondence: ; Tel.: +34-923-124465
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Ramesh J, Keeran N, Sagahyroon A, Aloul F. Towards Validating the Effectiveness of Obstructive Sleep Apnea Classification from Electronic Health Records Using Machine Learning. Healthcare (Basel) 2021; 9:healthcare9111450. [PMID: 34828496 PMCID: PMC8622500 DOI: 10.3390/healthcare9111450] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/23/2021] [Accepted: 10/25/2021] [Indexed: 11/20/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common, chronic, sleep-related breathing disorder characterized by partial or complete airway obstruction in sleep. The gold standard diagnosis method is polysomnography, which estimates disease severity through the Apnea-Hypopnea Index (AHI). However, this is expensive and not widely accessible to the public. For effective screening, this work implements machine learning algorithms for classification of OSA. The model is trained with routinely acquired clinical data of 1479 records from the Wisconsin Sleep Cohort dataset. Extracted features from the electronic health records include patient demographics, laboratory blood reports, physical measurements, habitual sleep history, comorbidities, and general health questionnaire scores. For distinguishing between OSA and non-OSA patients, feature selection methods reveal the primary important predictors as waist-to-height ratio, waist circumference, neck circumference, body-mass index, lipid accumulation product, excessive daytime sleepiness, daily snoring frequency and snoring volume. Optimal hyperparameters were selected using a hybrid tuning method consisting of Bayesian Optimization and Genetic Algorithms through a five-fold cross-validation strategy. Support vector machines achieved the highest evaluation scores with accuracy: 68.06%, sensitivity: 88.76%, specificity: 40.74%, F1-score: 75.96%, PPV: 66.36% and NPV: 73.33%. We conclude that routine clinical data can be useful in prioritization of patient referral for further sleep studies.
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