阻塞性睡眠呼吸暂停低通气综合征与血脂水平相关性的meta分析

doi:10.3969/j.issn.1004-583X.2021.03.001

摘要/Abstract

摘要：

目的系统评价阻塞性呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)与血脂水平的相关性,探讨OSAHS患者血脂水平变化的临床意义。方法计算机检索PubMed、Cochrane Library、中国学术期刊全文数据库(CNKI)、维普网、万方数据库,对纳入文献和相关综述的参考文献进行手工检索,查找公开发表的有关OSAHS与血脂水平相互关系的病例对照研究,检索时限均为建库至2018年12月。由2位研究者独立进行筛选、提取资料和评价偏倚风险后,采用RevMan5.3软件进行meta分析。结果通过筛选,总共纳入9个研究,包括1473个患者。Meta分析结果显示,OSAHS患者的甘油三酯[MD=0.60, 95%CI(0.54,0.67),P<0.01]及低密度脂蛋白[MD=0.25, 95%CI(0.02,0.49), P<0.01]水平高于对照组,高密度脂蛋白[MD=-0.17, 95%CI(-0.25,-0.08), P<0.01]水平低于对照组。结论 Meta分析结果表明,OSAHS患者常合并有血脂异常,然而,因为受纳入研究数量及研究质量的限制,上述结论及相关机制仍需更高质量及更大样本的试验研究进一步验证。

关键词: 睡眠呼吸暂停综合征, 鼾症, 血脂, meta分析

Abstract:

Objective To systematically evaluate the correlation between obstructive sleep apnea hypopnea syndrome (OSAHS) and serum lipid levels, and to explore the clinical significance of changes in serum lipid levels of OSAHS patients. Methods PubMed, Cochrane Library, CNKI, VIP and Wanfang database were searched. The literatures and references enrolled were manually searched to find the published case-control studies on the relationship between OSAHS and serum lipid levels. The retrieval time was from the establishment of the database to December 2018. Meta-analysis was conducted with revman5.3 software after screening, extracting data and evaluating the risk of bias by two researchers independently. Results A total of 9 studies including 1473 patients, were enrolled in the screening. The results of meta-analysis showed that triglycerides (MD=0.60, 95%CI[0.54, 0.67], P<0.01) and low-density lipoprotein levels (MD=0.25, 95%CI[0.02, 0.49], P<0.01) in OSAHS patients were higher than those in control group, while the level of high-density lipoprotein (MD=-0.17, 95%CI[-0.25, -0.08], P<0.01) was lower than that in the control group. Conclusion The results of meta-analysis indicate that patients with OSAHS often have dyslipidemia. However, due to the limited number of studies and the quality of them, the above conclusions and related mechanisms still require experimental research with higher quality and larger samples to further verify.

Key words: sleep apnea syndromes, snoring disease, serum lipids, meta-analysis

中图分类号:

R563.8

赵冲, 刘中洋, 徐峰, 李华丰. 阻塞性睡眠呼吸暂停低通气综合征与血脂水平相关性的meta分析[J]. 临床荟萃, 2021, 36(3): 197-202.

Zhao Chong, Liu Zhongyang, Xu Feng, Li Huafeng. Meta-analysis of the relationship between obstructive sleep apnea hypopnea syndrome and serum lipid levels[J]. Clinical Focus, 2021, 36(3): 197-202.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.03.001

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I3/197

图/表 8

参考文献 27

[1]	Strollo PJ Jr, Rogers RM. Obstructive sleep apnea[J]. N Engl J Med, 1996,334(2):99-104. doi: 10.1056/NEJM199601113340207 URL
[2]	Malhotra A, White DP. Obstructive sleep apnoea[J]. Lancet, 2002,360(9328):237-45. pmid: 12133673
[3]	Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study[J]. JAMA, 2000,283(14):1829-1836. doi: 10.1001/jama.283.14.1829 URL
[4]	Peppard PE, Young T, Palta M, et al. Prospective study of the association between sleep-disordered breathing and hypertension[J]. N Engl J Med, 2000,342(19):1378-1384. doi: 10.1056/NEJM200005113421901 URL
[5]	Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study[J]. Am J Respir Crit Care Med, 2001,163(1):19-25. doi: 10.1164/ajrccm.163.1.2001008 URL
[6]	Peker Y, Hedner J, Norum J, Carlson J, et al. Increased incidence of cardiovascular disease in middle-aged men with obstructive sleep apnea: a 7-year follow-up[J]. Am J Respir Crit Care Med, 2002,166(2):159-165. doi: 10.1164/rccm.2105124 URL
[7]	Imadojemu VA, Gleeson K, Gray KS, et al. Obstructive apnea during sleep is associated with peripheral vasoconstriction[J]. Am J Respir Crit Care Med, 2002,165(1):61-66. doi: 10.1164/ajrccm.165.1.2009062 URL
[8]	Sajkov D, Wang T, Saunders NA, et al. Continuous positive airway pressure treatment improves pulmonary hemodynamics in patients with obstructive sleep apnea[J]. Am J Respir Crit Care Med, 2002,165(2):152-158. doi: 10.1164/ajrccm.165.2.2010092 URL
[9]	Amin RS, Kimball TR, Bean JA, et al. Left ventricular hypertrophy and abnormal ventricular geometry in children and adolescents with obstructive sleep apnea[J]. Am J Med Genet A, 2004,126A(1):18-26. doi: 10.1002/(ISSN)1096-8628 URL
[10]	Rebuffè-scrive M, Mårin P, Björntorp P. Effect of testosterone on abdominal adipose tissue in men[J]. Int J Obes, 1991,15(11):791-795.
[11]	Steven RC, Lynn M, Julie AM, et al. Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome[J]. European Heart Journal, 2004,25(9):735-741. doi: 10.1016/j.ehj.2004.02.021 URL
[12]	Gruber A, Horwood F, Sithole J, et al. Obstructive sleep apnoea is independently associated with the metabolic syndrome but not insulin resistance state[J]. Cardiovasc Diabetol, 2006,5(1):15-22. doi: 10.1186/1475-2840-5-15 URL
[13]	Tan KC, Chow WS, Lam JC, et al. HDL dysfunction in obstructive sleep apnea[J]. Atherosclerosis, 2006,184(2):377-382. doi: 10.1016/j.atherosclerosis.2005.04.024 URL
[14]	Redline S, Storfer-isser A, Rosen CL, et al. Association between metabolic syndrome and sleep-disordered breathing in adolescents[J]. Am J Respir Crit Care Med, 2007,176(4):401-408. doi: 10.1164/rccm.200703-375OC URL
[15]	Lin QC, Zhang XB, Chen GP, et al. Obstructive sleep apnea syndrome is associated with some components of metabolic syndrome in nonobese adults[J]. Sleep Breath, 2012,16(2):571-578. doi: 10.1007/s11325-011-0544-7 URL
[16]	王艳飞. 脑梗死合并睡眠呼吸暂停综合征相关危险因素的分析[J]. 临床医学研究与实践, 2018,3(4):80-81.
[17]	李洁. 阻塞性睡眠呼吸暂停患者中脂代谢异常及相关因素研究[D]. 苏州大学, 2016.
[18]	王莹. 阻塞性睡眠呼吸暂停低通气综合征合并高血压患者血压及血浆脂类水平的变化[D]. 吉林大学, 2004.
[19]	Prospective Studies Collaboration, Lewington s, Whitlock G, et al. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55, 000 vascular deaths[J]. Lancet, 2007,370(9602):1829-1839. pmid: 18061058
[20]	National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel Ⅲ). Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel Ⅲ) final report[J]. Circulation, 2002,106(25):3143-3421. doi: 10.1161/circ.106.25.3143 URL
[21]	Di Angelantonio E, Sarwar N, Perry P, et al. Major lipids, apolipoproteins, and risk of vascular disease[J]. JAMA, 2009,302(18):1993-2000. doi: 10.1001/jama.2009.1619 pmid: 19903920
[22]	上海市医学会呼吸病学分会睡眠呼吸疾病学组. 上海市30岁以上人群阻塞性睡眠呼吸暂停低通气综合征流行病学调查[J]. 中华结核和呼吸杂志, 2003,26(5):15-19.
[23]	李明娴, 王莹, 华树成, 等. 长春市20岁以上人群阻塞性睡眠呼吸暂停低通气综合征流行病学现况调查[J]. 中华结核和呼吸杂志, 2005,28(12):833-835.
[24]	Yaggi HK, Araujo AB, Mckinlay JB. Sleep duration as a risk factor for the development of type 2 diabetes[J]. Diabetes Care, 2006,29(3):657-661. pmid: 16505522
[25]	王蓓, 刘卓拉, 宋满景, 等. 生长激素对阻塞性睡眠呼吸暂停综合征患者代谢的影响[J]. 中华内科杂志, 1999,38(10):47-48.
[26]	Börgel J, Sanner BM, Bittlinsky A, et al. Obstructive sleep apnea and its therapy influence high-density lipoprotein cholesterol serum levels[J]. Eur Respir J, 2006,27(1):121-127. pmid: 16387944
[27]	Adedayo AM, Olafiranye O, Smith D, et al. Obstructive sleep apnea and dyslipidemia: evidence and underlying mechanism[J]. Sleep Breath, 2014,18(1):13-18. doi: 10.1007/s11325-012-0760-9 URL

作者	发表年份	纳入人数 (病例组/对照组)	年龄(岁)		性别(男/女,例)		观测指标
作者	发表年份	纳入人数 (病例组/对照组)	病例组	对照组	病例组	对照组	观测指标
Gruber等	2006	38/41	51.0±2.0	47.3±1.7	-	-	①②③④
Steven等	2004	61/43	49.6±1.2	47.1±1.4	-	-	①④
王莹等	2004	32/30	44.1±6.4	43.2±6.5	26/6	24/6	①②③④
Lin等	2011	154/45	48.1±14.4	47.0±12.8	91/22	38/7	①③④
Kathry等	2006	128/82	48.5±10.8	43.4±11.6	102/26	45/37	①③④
Susan等	2007	22/248	13.4±0.5	13.6±0.7	17/5	123/125	②③④
李洁等	2016	119/126	56.8±13.3	58.7±15.7	87/32	71/55	①②③④
王艳飞等	2018	32/43	53.3±4.7	56.2±3.9	17/15	23/20	①②③④
宋卫卫等	2017	235/35	-	-	193/42	20/15	①②③④

作者	发表年份	纳入人数 (病例组/对照组)	年龄(岁)		性别(男/女,例)		观测指标
作者	发表年份	纳入人数 (病例组/对照组)	病例组	对照组	病例组	对照组	观测指标
Gruber等	2006	38/41	51.0±2.0	47.3±1.7	-	-	①②③④
Steven等	2004	61/43	49.6±1.2	47.1±1.4	-	-	①④
王莹等	2004	32/30	44.1±6.4	43.2±6.5	26/6	24/6	①②③④
Lin等	2011	154/45	48.1±14.4	47.0±12.8	91/22	38/7	①③④
Kathry等	2006	128/82	48.5±10.8	43.4±11.6	102/26	45/37	①③④
Susan等	2007	22/248	13.4±0.5	13.6±0.7	17/5	123/125	②③④
李洁等	2016	119/126	56.8±13.3	58.7±15.7	87/32	71/55	①②③④
王艳飞等	2018	32/43	53.3±4.7	56.2±3.9	17/15	23/20	①②③④
宋卫卫等	2017	235/35	-	-	193/42	20/15	①②③④