德国与韩国人群睡眠呼吸障碍的比较队列分析

文献信息

中文摘要

背景： 睡眠呼吸障碍（SDB）十分常见，并与肥胖、高血压、糖尿病、血脂异常及心血管风险密切相关。然而，大多数证据来自以西方人群为主的研究，目前尚不清楚在不同人体测量特征和疾病风险谱的人群中，SDB、肥胖与心血管代谢健康之间的关系是否具有可比性。因此，需要在地域和种族上不同的人群队列之间进行统一化比较，以确定相似水平的SDB在不同人群中是否具有相同的临床意义。
方法： 数据来自波美拉尼亚健康研究（SHIP-TREND；德国）和韩国基因组与流行病学研究（KoGES；韩国）。对临床、实验室和多导睡眠图测量指标进行了统一化处理。纳入年龄≥45岁、睡眠记录可用且总睡眠时间≥4小时的参与者。采用逆概率加权以平衡队列间的年龄和性别分布。回归模型检验了体重指数（BMI）和腰高比（WHtR）与呼吸暂停低通气指数（AHI）的关联，以及AHI与糖尿病、高血压、血脂标志物和Framingham 10年心血管风险评分的关联。
结果： 分析纳入768名SHIP-TREND参与者和2867名KoGES参与者。SDB严重程度随年龄增加，且男性更高。在两个队列中，较高的肥胖程度均与较高的AHI相关，但BMI-AHI关联在KoGES中更强。校正WHtR后，高血压仍与KoGES中的AHI相关，但在SHIP-TREND中不相关；糖尿病、血脂和心血管风险关联大体相当，尽管绝对疾病负担存在人群差异。
结论： SDB在德国和韩国人群中具有不同的心血管代谢意义，反映了肥胖相关易感性和潜在疾病负担的差异。因此，AHI应结合适合该人群的肥胖和心血管代谢风险指标进行解读。

英文摘要

BACKGROUND: Sleep-disordered breathing (SDB) is common and is closely associated with obesity, hypertension, diabetes, dyslipidaemia, and cardiovascular risk. However, most evidence has been generated in predominantly Western populations, and it remains unclear whether the relationship between SDB, adiposity, and cardiometabolic health is comparable across populations with different anthropometric and disease-risk profiles. Harmonised comparisons between geographically and ethnically distinct population-based cohorts are therefore needed to determine whether a similar level of SDB carries the same clinical implications across populations.
METHODS: Data were drawn from the Study of Health in Pomerania (SHIP-TREND; Germany) and the Korean Genome and Epidemiology Study (KoGES; South Korea). Clinical, laboratory, and polysomnographic measures were harmonised. Participants aged ≥45 years with useable sleep recordings and ≥4 h of total sleep time were included. Inverse probability weighting balanced age and sex distributions between cohorts. Regression models examined associations of body mass index (BMI) and waist-to-height ratio (WHtR) with Apnea-Hypopnea Index (AHI), and associations of AHI with diabetes, hypertension, lipid markers, and Framingham 10-year cardiovascular risk scores.
RESULTS: Analyses included 768 SHIP-TREND and 2867 KoGES participants. SDB severity increased with age and was higher in men. Higher adiposity was associated with higher AHI in both cohorts, but the BMI-AHI association was stronger in KoGES. After WHtR adjustment, hypertension remained associated with AHI in KoGES but not SHIP-TREND; diabetes, lipids, and cardiovascular risk associations were broadly comparable although there were population differences in absolute burden.
CONCLUSIONS: SDB carries distinct cardiometabolic implications across German and South Korean populations, reflecting differences in adiposity related susceptibility and underlying disease burden. AHI should therefore be interpreted alongside population appropriate measures of adiposity and cardiometabolic risk.