2022年 · 第102卷第08期

A growing body of research suggests that inflammation may contribute to the development of obstructive sleep apnea (OSA). However, most of these studies are cross-sectional studies, and there is still a lack of prospective studies to explore the role of inflammation in the development of OSA. Whether the changes in inflammatory characteristics occur before or after the onset of OSA, or both, remains to be clarified. Subjects in this study were from four US cohorts: the Nurses Health Study (NHS), the Nurses Health Study II (NHS II), the Health Professionals Follow-up Study (HPFS), and the Multi-Ethnic Atherosclerosis Study (MESA). None of these subjects had been diagnosed with OSA at baseline. C-reactive protein (CRP) is a sensitive but non-specific marker of inflammation, and this study measured baseline CRP levels in subjects from 4 cohorts and followed up to assess the association between circulating CRP levels and OSA risk. After 10 to 18 years of follow-up, adjusted for multivariate outside BMI, for every 1-fold increase in baseline CRP level, the total risk of OSAORThe value was 1.24 (95%CI: 1.18 to 1.30), indicating that higher baseline CRP levels are associated with increased risk of OSA. Although this association weakened after adjusting for BMI, a positive association between CRP and OSA risk persisted, especially in young adults, underweight/normal weight individuals, or premenopausal women. Considering that increasing age, increased BMI, and postmenopausal status are recognized risk factors for OSA, the results of this study suggest that inflammation may be an important pathogenic mechanism in patients with early-onset OSA without traditional risk factors for OSA. In addition, CRP was found to be more closely associated with an increased risk of development of an OSA phenotype characterized by excessive daytime somnolence (EDS) and an endotype of OSA characterized by high airway collapsibility and low arousal threshold. This study provides prospective evidence to reveal the role of inflammation in the pathogenesis of OSA, extending previous evidence about inflammation-related diseases or pro-inflammatory lifestyles increasing the risk of OSA.

Obesity is a major risk factor for obstructive sleep apnea (OSA). Short-term clinical trials have reported that weight loss can lead to an improvement in the severity of OSA. The greater the weight loss in participants who received the active intervention, the more pronounced the improvement in the apnea-hypopnea index (AHI), a measure of OSA severity. But the long-term effects of intensive lifestyle interventions on the severity of OSA remain unclear. "Sleep AHEAD (Action for Health in Diabetes)" is a randomized controlled trial of OSA patients with type 2 Diabetes and overweight obesity comparing the impact of an intensive lifestyle intervention (ILI) focused on weight loss with Diabetes support and education (DSE) on OSA severity. The primary objective of this study was to determine whether the ILI intervention resulted in an improvement in AHI during the 10-year follow-up. The results showed that OSA patients with type II diabetes and overweight and obesity who received ILI focused on weight loss significantly reduced the severity of OSA at 10 years. But between-group differences in improvement in OSA severity in ILI versus DSE participants during the first 4 years were no longer statistically significant at 10-year follow-up. Nonetheless, the overall decrease in AHI was greater in the ILI group than in the DSE group at the 10-year follow-up. The findings also found that improvements in OSA severity over a 10-year period were associated with weight change, baseline AHI, and intervention ILI independent of weight change. This study is the longest randomized controlled trial to date to evaluate the effect of ILI weight management on the severity of OSA. The results of the study suggest that if weight loss is persisted for a long time, it will significantly improve the severity of OSA, thus increasing the acceptance of this treatment plan.