教育水平对中老年中国睡眠呼吸障碍患者临床特征分层及氧减指数相关因素的作用

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中文摘要

背景： 本研究旨在探讨中老年中国中重度睡眠呼吸障碍（SDB）患者在不同教育水平间人口学、临床和心理特征的差异，并识别与氧减指数（ODI）相关的因素及潜在的统计学间接效应。我们进一步检验教育水平是否调节心理症状与ODI之间的关系。
方法： 共招募306例中重度SDB患者，并采用严格的排除标准。所有参与者均接受腕式脉搏血氧仪整夜监测以计算ODI（每小时≥3%且持续≥3秒的氧减事件）。收集人口学信息、病史和问卷评分（嗜睡、失眠、焦虑、抑郁、疲劳、生活质量）。患者被分为较低教育水平组（小学或未上学）和较高教育水平组（初中及以上）。采用预先设定的多变量线性回归模型和统计学中介分析。进行了年龄和性别调整的组间比较。
结果： 在306例患者中，178例属于较低教育水平组，128例属于较高教育水平组。经年龄和性别调整后，较高教育水平组的ODI、BMI、月收入、饮酒、日间嗜睡、失眠、焦虑和抑郁评分较高，但疲劳较少。多变量调整后，教育水平与ODI无独立关联。在总体样本中，BMI（标准化beta=0.252，P<0.001）和平均月收入（标准化beta=0.24，P=0.001）是ODI的独立相关因素。BMI在统计学上解释了平均月收入与ODI关联的27.3%。使用预先设定回归模型的亚组分析显示，在较低教育水平组中GAD-7焦虑评分与ODI呈正相关（标准化beta=0.372，P<0.05），而在较高教育水平组中BMI（标准化beta=0.324，P=0.002）和平均月收入（标准化beta=0.219，P=0.048）与ODI呈正相关。较高教育亚组的结果与总体样本结果一致。
结论： 教育水平与ODI无直接关联，但在SDB患者中分层出不同的临床和心理特征以及异质的ODI相关因素。在较低教育组中，焦虑（GAD-7）成为ODI的独立相关因素，而在较高教育组中，BMI和收入占主导，这些发现与总体样本一致。BMI和收入是ODI的独立相关因素，BMI在统计学上解释了收入-ODI关联的一部分。这些横断面发现强调需要对SDB评估采取按教育水平分层的方法，尤其关注较低教育人群中的焦虑症状。

英文摘要

BACKGROUND: This study aimed to explore differences in demographic, clinical, and psychological characteristics among middle-aged and elderly Chinese patients with moderate-to-severe sleep-disordered breathing (SDB) across educational levels, and to identify factors associated with the oxygen desaturation index (ODI) as well as potential statistical indirect effects. We further examined whether educational level moderates the relationship between psychological symptoms and ODI.
METHODS: A total of 306 patients with moderate-to-severe SDB were recruited with strict exclusion criteria. All participants underwent overnight monitoring with a wrist pulse oximeter to calculate ODI (oxygen desaturation events ≥3% lasting ≥3 s per hour). Demographic information, medical history, and questionnaire scores (sleepiness, insomnia, anxiety, depression, fatigue, quality of life) were collected. Patients were divided into lower (primary school or unschooled) and higher (junior high school or above) educational level groups. A predefined multivariable linear regression model and statistical mediation analysis were used. Age- and sex-adjusted group comparisons were performed.
RESULTS: Among 306 patients, 178 were in the lower educational level group and 128 in the higher educational level group. After age and sex adjustment, the higher educational level group had higher ODI, BMI, monthly income, alcohol use, daytime sleepiness, insomnia, anxiety, and depression scores, but less fatigue. Educational level was not independently associated with ODI after multivariable adjustment. In the overall sample, BMI (standardized beta = 0.252, P < 0.001) and average monthly income (standardized beta = 0.24, P = 0.001) were independent correlates of ODI. BMI statistically accounted for 27.3% of the association between average monthly income and ODI. Subgroup analyses using the predefined regression model showed that GAD-7 anxiety score was positively associated with ODI in the lower educational level group (standardized beta = 0.372, P < 0.05), while BMI (standardized beta = 0.324, P = 0.002) and average monthly income (standardized beta = 0.219, P = 0.048) were positively associated with ODI in the higher educational level group. The higher education subgroup findings were consistent with the overall sample results.
CONCLUSION: Educational level is not directly associated with ODI but stratifies distinct clinical and psychological profiles and heterogeneous ODI-associated factors in patients with SDB. In the lower education group, anxiety (GAD-7) emerges as an independent correlate of ODI, while in the higher education group, BMI and income predominate, findings consistent with the overall sample. BMI and income are independent correlates with ODI, with BMI statistically accounting for a portion of the income-ODI association. These cross-sectional findings highlight the need for education-stratified approaches to SDB assessment, with particular attention to anxiety symptoms in lower-educated populations.