阻塞性睡眠呼吸暂停与甘油三酯葡萄糖指数的相关性

Correlation between obstructive sleep apnea and triglyceride glucose index

摘要:

目的 探讨阻塞性睡眠呼吸暂停（OSA）与甘油三酯葡萄糖（TyG）指数的相关性。方法 选取2021年1月—2022年12月中南大学湘雅二医院行睡眠呼吸监测的270例OSA患者。根据甘油三酯和空腹血糖计算TyG指数，根据TyG指数的三分位数将患者分为Q1组、Q2组、Q3组，根据睡眠呼吸暂停低通气指数（AHI）将患者分为轻度组、中度组、重度组。采用多元线性分析评估TyG指数与AHI之间的关系，有序Logistic回归分析TyG指数与OSA严重程度之间的关系。结果 TyG指数越高的患者AHI、体质量指数（BMI）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖越高，而血清高密度脂蛋白胆固醇（HDL-C）水平则越低（P <0.05）。TyG指数越高的患者肥胖和糖尿病、冠心病比例越高，男性比例越高，年龄更低（P <0.05）。随着患者AHI的增加，TyG指数、BMI增加，TG、空腹血糖上升，最低血氧饱和度下降（P <0.05），OSA越严重的患者肥胖、高血压和冠心病比例越高（P <0.05）。Pearson相关性分析结果显示，TyG指数与AHI水平呈正相关（r =0.282，P <0.05）。多元线性回归分析结果显示，AHI（b =0.002）、BMI（b =0.017）、TG（b =0.361）、空腹血糖（b =0.109）和性别（b =0.083）是TyG的影响因素（P <0.05）。有序Logistic模型结果显示：轻度OSA［O^R=0.396（95% CI：0.207，0.757）］和中度OSA［O^R=0.281（95% CI：0.163，0.484）］患者的TyG等级较重度OSA低，说明OSA严重程度增加是TyG指数升高的影响因素。非肥胖患者［O^R=0.424（95% CI：0.253，0.710）］、不吸烟患者［O^R=0.506（95% CI：0.283，0.904）］、非糖尿病患者［O^R=0.268（95% CI：0.156，0.460）］、非冠心病患者［O^R=0.452（95% CI：0.253，0.807）］、女性［O^R=0.409（95% CI：0.221，0.760）］的TyG等级较低，故吸烟、肥胖、糖尿病、冠心病、男性是TyG指数升高的影响因素（P <0.05）。结论 TyG指数与OSA严重程度相关，可以考虑将TyG指数用于OSA患者胰岛素抵抗的观察，从而进行干预，使患者获益。

Abstract:

Objective To investigate the correlation between obstructive sleep apnea (OSA) and triglyceride glucose (TyG) index.Methods A total of 270 patients with obstructive sleep apnea (OSA) undergoing sleep breathing monitoring in the Second Xiangya Hospital of Central South University from January 2021 to December 2022 were included. The TyG index was calculated based on blood triglycerides and fasting blood glucose (FBG), and the patients were divided into three groups (Q1, Q2, and Q3 groups) according to the tertile of the TyG index. On the basis of the apnea-hypopnea index (AHI), patients were instead divided into mild, moderate, and severe groups. Multiple linear regression analysis was used to evaluate the correlation between TyG index and AHI, and ordinal Logistic regression analysis was performed to determine the correlation between TyG index and the severity of OSA.Results Patients with higher TyG index also exhibited higher AHI, BMI, and levels of TC, TG, LDL-C and FBG but lower levels of HDL-C (P < 0.05). Among those with higher TyG index, the proportions of individuals with obesity, diabetes mellitus, and coronary heart disease were higher, the frequency of males was higher, and the age of patients was lower (P < 0.05). With the increase in AHI, the TyG index, BMI and the levels of TG and FBG were elevated, while the minimum oxygen saturation was declined (P < 0.05). The proportions of patients with obesity, hypertension, and coronary heart disease were higher among those with severer OSA (P < 0.05). The Pearson correlation analysis demonstrated that the TyG index was positively correlated with AHI (r =0.282, P < 0.05). The multiple linear regression analysis further revealed that AHI (b = 0.002), BMI (b = 0.017), TG (b = 0.361), FBG (b = 0.109) and sex (b = 0.083) were factors affecting the TyG index (P < 0.05). The ordinal Logistic regression analysis exhibited that the degree of the TyG index in patients with mild OSA [O^R = 0.396 (95% CI: 0.207, 0.757) ] and moderate OSA [O^R = 0.281 (95% CI: 0.163, 0.484) ] was lower than that in patients with severe OSA, indicating that the increase in the severity of OSA affected the alteration in TyG index. Non-obese patients [O^R = 0.424 (95% CI: 0.253, 0.710) ], non-smokers [O^R = 0.506 (95% CI: 0.283, 0.904) ], patients without diabetes mellitus [O^R = 0.268 (95% CI: 0.156, 0.460) ] and coronary heart disease [O^R = 0.452 (95% CI: 0.253, 0.807) ], and female patients [O^R = 0.409 (95% CI: 0.221, 0.760) ] had lower degree of TyG index, suggesting that smoking, being afflicted with obesity, diabetes mellitus, and coronary heart disease, and being male may contribute to the increase in the TyG index (P < 0.05).Conclusions The TyG index is correlated with the severity of OSA. Thus, the TyG index may be applied to monitor the IR of OSA patients for assisting further possible interventions, thereby benefiting these patients.