The Association of High Arousal Threshold with Hypertension and Diabetes in Obstructive Sleep Apnea

Abstract

Objective

Compared to low arousal threshold (AT), high AT is an easily overlooked characteristic for obstructive sleep apnea (OSA) severity estimation. This study aims to evaluate the relationship between high AT, hypertension and diabetes in OSA, compared to those with apnea–hypopnea index (AHI).

Methods

A total of 3400 adults diagnosed with OSA were retrospectively recruited. Propensity score matching (PSM) was conducted to further categorize these patients into the low and high AT groups based on the strategy established by previous literature. The different degrees of AHI and quantified AT (AT score) were subsequently measured. The correlation of AT and AHI with the occurrence of various comorbidities in OSA was estimated by logistic regression analysis with odds ratio (OR).

Results

After PSM, 938 pairs of patients arose. The median AT score of high and low AT group was 21.7 and 12.2 scores, and the adjusted OR of high AT for hypertension and diabetes was 1.31 (95% CI = 1.07–1.62, P < 0.01) and 1.45 (95% CI = 1.01–2.08, P < 0.05), respectively. Compared to low AT score group, the OR significantly increased in patients with very high AT score (30 ≤ AT score), especially for diabetes (OR = 1.79, 95% CI = 1.02–3.13, P < 0.05). The significant association was not observed in AHI with increasing prevalent diabetes.

Conclusion

Higher AT is significantly associated with increased prevalence of hypertension and diabetes in patients with OSA. Compared with AHI, AT score is a potentially comprehensive indicator for better evaluating the relationship between OSA and related comorbidities.

Keywords:

• obstructive sleep apnea
• arousal threshold
• apnea–hypopnea index
• hypertension
• diabetes

Data Sharing Statement

The data used to support the findings of this study are available from the corresponding author upon request.

Acknowledgments

We would like to thank Professor Nanshan Zhong from State Key Laboratory of Respiratory Disease for the constructive advice he gave. We thank Home for Researchers editorial team for language editing service.

Disclosure

The authors have no conflicts of interest to report for this work.

Additional information

Funding

This research project was supported by Basic Research Project (Dengfeng hospital) jointly Funded by Guangzhou City and the School (No.202201020586) and the Natural Science Foundation of Guangdong Province China (No. 2019A1515010981).