阻塞性睡眠呼吸暂停中血清催乳素与总抗氧化状态的差异性相关模式：一项横断面研究

文献信息

中文摘要

背景： 阻塞性睡眠呼吸暂停（OSA）的严重程度分类主要依赖呼吸暂停低通气指数（AHI），该指数量化事件频率，但不能反映事件持续时间或低氧负荷。我们检验了血清催乳素和总抗氧化状态（TAS）是否与基于频率和基于持续时间的多导睡眠图参数表现出差异性相关模式，这可能反映不同的病理生理机制。方法：这项横断面研究纳入55名参与者（对照组：n=12，AHI<5；轻/中度OSA：n=22，5≤AHI<30；重度OSA：n=21，AHI≥30），均接受整夜多导睡眠监测。测量空腹血清催乳素和TAS。采用Spearman相关分析检验生物标志物与AHI（在本队列中数值上等同于呼吸紊乱指数）、氧减指数、总呼吸暂停低通气持续时间、最长呼吸暂停持续时间和最低血氧饱和度的关联；使用Benjamini-Hochberg错误发现率程序对P值进行多重检验校正。结果：催乳素（22.7±9.8 vs 14.7±7.2 vs 12.7±7.3 ng/mL，P=.007）和TAS（1.181±0.068 vs 1.122±0.065 vs 1.111±0.057 mmol/L，P=.021）均随严重程度分组呈进行性下降。TAS与事件频率相关（AHI：r=-0.419，q=0.013），但与最长呼吸暂停持续时间不相关（r=-0.223，q=0.103），而催乳素既与频率相关（AHI：r=-0.360，q=0.017），也与持续时间参数相关（最长呼吸暂停持续时间：r=-0.288，q=0.044）。然而，当使用Steiger Z检验对依赖相关直接比较每个参数的TAS和催乳素相关性时，所有差异均未达到统计学显著性（所有P≥.65），表明这种表面上的差异反映的是不同的显著性阈值，而非正式确认的关联强度差异。催乳素与最低血氧饱和度之间的正相关在错误发现率校正后未保留显著性（q=0.053），被视为探索性结果。结论：TAS和催乳素与基于频率和基于持续时间的多导睡眠图参数表现出描述性不同的相关模式；然而，直接统计学比较并未确认这些差异具有显著性，这些发现应被视为产生假设，而非不同病理生理机制的确认证据。需要更大规模的独立队列来正式检验这些生物标志物在与OSA严重程度维度的关联上是否存在差异。

英文摘要

Obstructive sleep apnea (OSA) severity classification relies primarily on the Apnea-Hypopnea Index (AHI), which quantifies event frequency but does not capture event duration or hypoxemic burden. We examined whether serum prolactin and total antioxidant status (TAS) show differential correlation patterns with frequency- versus duration-based polysomnographic parameters, potentially reflecting distinct pathophysiological mechanisms. This cross-sectional study enrolled 55 participants (controls: n = 12, AHI < 5; mild/moderate OSA: n = 22, 5 ≤ AHI < 30; severe OSA: n = 21, AHI ≥ 30) undergoing overnight polysomnography. Fasting serum prolactin and TAS were measured. Spearman correlations examined biomarker associations with AHI (numerically equivalent to the Respiratory Disturbance Index in this cohort), oxygen desaturation index, total apnea-hypopnea duration, longest apnea duration, and lowest oxygen saturation; P-values were adjusted for multiple testing using the Benjamini-Hochberg false discovery rate procedure. Both prolactin (22.7 ± 9.8 vs 14.7 ± 7.2 vs 12.7 ± 7.3 ng/mL, P = .007) and TAS (1.181 ± 0.068 vs 1.122 ± 0.065 vs 1.111 ± 0.057 mmol/L, P = .021) decreased progressively across severity groups. TAS correlated with event frequency (AHI: r = -0.419, q = 0.013) but not with longest apnea duration (r = -0.223, q = 0.103), while prolactin correlated with both frequency (AHI: r = -0.360, q = 0.017) and duration parameters (longest apnea duration: r = -0.288, q = 0.044). However, when TAS and prolactin correlations were compared directly for each parameter using Steiger Z test for dependent correlations, none of the differences reached statistical significance (all P ≥ .65), indicating that this apparent divergence reflects differing significance thresholds rather than a formally confirmed difference in association strength. A positive correlation between prolactin and lowest oxygen saturation did not retain significance after false discovery rate correction (q = 0.053) and is considered exploratory. TAS and prolactin show descriptively different correlation patterns with frequency- and duration-based polysomnographic parameters; however, direct statistical comparison did not confirm these differences as significant, and the findings should be regarded as hypothesis-generating rather than confirmed evidence of distinct pathophysiological mechanisms. Larger, independent cohorts are needed to formally test whether these biomarkers diverge in their associations with OSA severity dimensions.