血红蛋白在高海拔地区与阻塞性睡眠呼吸暂停呈U型关联：机器学习和探索性干预证据
Hemoglobin Exhibits a U-Shaped Association with Obstructive Sleep Apnea at High Altitude: Machine-Learning and Exploratory Interventional Evidence.
文献信息
| PMID | 42855086 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Yuan-Zheng Xue |
| 作者单位 | 953rd Hospital of PLA, Shigatse, China; Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing, China. |
| 期刊 | Respiratory medicine |
| SCI 分区 | Q2 |
| IF | 3.6 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
目的： 慢性高海拔缺氧诱导适应性红细胞增多，但血红蛋白（Hb）与阻塞性睡眠呼吸暂停（OSA）之间的关系仍不清楚。我们检查了Hb水平与OSA严重程度之间的关联，并探讨了红细胞去除术后睡眠相关结局的短期变化。
方法： 在海拔3,860米处招募了250名居住在海拔3,000米以上至少1年的男性。通过便携式多导睡眠监测评估OSA（呼吸暂停低通气指数，AHI；氧合）。参与者按Hb水平分层（<170、170-210和≥210 g/L）。使用机器学习分类和限制性立方样条（RCS）分析评估Hb-OSA的非线性关联。在子研究中，15名Hb >240 g/L的参与者接受了红细胞去除术，15名同期高海拔红细胞增多症（HAPC）参与者仅接受氧疗。在24-48小时内重新评估睡眠。
结果： 观察到Hb与AHI之间呈U型关系，170-210 g/L组的AHI最低（P < 0.001）。RCS分析证实了显著的非线性关联（P < 0.001）。用于OSA分类的机器学习模型达到AUC 0.873，BMI、日间SpO2和Hb偏差有助于风险分层。在探索性子研究中，与单独氧疗相比，红细胞去除术与Hb和AHI的短期更大降低以及夜间氧合改善相关。
结论： 在高海拔地区，Hb与OSA呈非线性U型关联。中间Hb水平（170-210 g/L）与更有利的睡眠相关指标相关。在HAPC参与者中，红细胞去除术与睡眠相关指标的短期改善相关，支持进一步对照评估。
英文摘要
OBJECTIVES: Chronic high-altitude hypoxia induces adaptive erythrocytosis, but the relationship between hemoglobin (Hb) and obstructive sleep apnea (OSA) remains unclear. We examined the association between Hb levels and OSA severity and explored short-term changes in sleep-related outcomes after erythrocytapheresis.
METHODS: 250 men residing ≥1 year above 3,000 m were recruited at 3,860 m. OSA was assessed by portable polysomnography (apnea-hypopnea index, AHI; oxygenation). Participants were stratified by Hb level (<170, 170-210, and ≥210 g/L). Machine-learning classification and restricted cubic spline (RCS) analyses were used to evaluate nonlinear Hb-OSA associations. In the substudy, 15 participants with Hb >240 g/L underwent erythrocytapheresis, and 15 contemporaneous participants with high-altitude polycythemia (HAPC) received oxygen therapy alone. Sleep was reassessed within 24-48 h.
RESULTS: A U-shaped relationship between Hb and AHI was observed, with the lowest AHI in the 170-210 g/L group (P < 0.001). RCS analysis confirmed a significant nonlinear association (P < 0.001). The machine-learning model for OSA classification achieved an AUC of 0.873, with BMI, daytime SpO2, and Hb deviation contributing to risk stratification. In the exploratory substudy, erythrocytapheresis was associated with larger short-term reductions in Hb and AHI, and with improved nocturnal oxygenation, compared with oxygen therapy alone.
CONCLUSIONS: Hb showed a nonlinear, U-shaped association with OSA at high altitude. Intermediate Hb levels (170-210 g/L) were associated with more favorable sleep-related indices. Erythrocytapheresis was associated with short-term improvement in sleep-related measures among participants with HAPC, supporting further controlled evaluation.