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

Figures & data

Figure 1 Study flowchart.

Abbreviation: OSA, obstructive sleep apnea; PSM, propensity score matching; PSG, polysomnography.

Table 1 Baseline Characteristics of Participants with OSA Stratified by AT Before PSM (n=3400) and After PSM (n=1876)

	Before PSM			After PSM
	High AT Group (n = 1845)	Low AT Group (n = 1555)	P value	High AT Group (n = 938)	Low AT Group (n = 938)	P value
Demographic and clinical characteristics
Age, years	46.0 (36.0, 57.0)	49.0 (38.0, 59.0)	<0.001	47.0 (37.0, 58.0)	48.0 (37.0, 58.0)	0.867
BMI, kg/m^2	27.7 (25.4, 30.1)	26.2 (23.8, 28.5)	<0.001	26.6 (24.5, 29.1)	26.9 (24.6, 29.1)	0.498
NC, cm	40.0 (37.0, 42.0)	38.0 (35.5, 40.0)	<0.001	39.0 (37.0, 41.0)	39.0 (37.0, 41.0)	0.738
WC, cm	97.0 (91.0, 104.0)	94.0 (87.0, 100.0)	<0.001	96.0 (89.0, 102.0)	96.0 (90.0, 102.0)	0.291
Male, n (%)	1588 (86.1)	1092 (70.3)	<0.001	772 (82.3)	781 (83.3)	0.582
Smoking, n (%)	709 (38.4)	441 (28.4)	<0.001	352 (37.5)	327 (34.9)	0.230
Alcohol consumption, n (%)	574 (31.1)	373 (24.0)	<0.001	251 (26.8)	271 (28.9)	0.303
PSG parameters
AHI, events/h	48.1 (31.5, 64.5)	12.9 (8.5, 19.9)	<0.001	39.1 (23.4, 59.4)	14.9 (9.4, 22.5)	<0.001
ODI, events/h	44.9 (25.4, 64.1)	18.0 (10.1, 31.9)	<0.001	27.6 (14.7, 45.5)	25.2 (14.9, 42.1)	0.479
T90%, min	28.4 (7.9, 68.2)	1.5 (0.3, 6.2)	<0.001	10.9 (3.5, 28.7)	2.0 (0.4, 8.7)	<0.001
TST, min	429.0 (383.0, 471.0)	409.0 (358.0, 451.3)	<0.001	426.0 (385.0, 468.0)	411.2 (359.0, 454.0)	<0.001
MAI, events/h	29.8 (18.0, 45.4)	13.0 (8.5, 19.3)	<0.001	23.0 (14.0, 39.8)	14.7 (9.5, 22.0)	<0.001
WASO, min	35.0 (14.0, 71.5)	36.0 (15.0, 77.5)	0.145	33.5 (13.0, 72.8)	31.0 (10.0, 70.5)	0.332
Sleep efficiency, %	88.7 (80.8, 94.7)	86.9 (77.6, 93.1)	<0.001	86.9 (78.3, 92.9)	86.2 (77.0, 92.9)	0.095
N1, %	20.4 (11.0, 36.0)	16.6 (10.1, 27.5)	<0.001	26.5 (13.3, 41.0)	17.6 (10.8, 29.6)	<0.001
N2, %	55.9 (41.9, 68.2)	56.3 (44.3, 65.7)	0.085	48.1 (36.3, 60.2)	55.1 (43.0, 65.6)	<0.001
N3, %	3.9 (0.0, 11.3)	8.0 (1.4, 15.1)	<0.001	8.4 (2.2, 15.2)	8.0 (1.2, 15.2)	0.317
REM, %	13.6 (9.0, 18.2)	15.0 (9.9, 19.7)	<0.001	12.9 (7.3, 18.0)	14.3 (9.4, 19.0)	<0.001
MSpO2, %	94.0 (92.0, 95.0)	95.0 (93.0, 96.0)	<0.001	95.0 (93.0, 96.0)	94.0 (93.0, 96.0)	<0.001
LSpO2, %	71.0 (62.0, 79.0)	85.0 (82.0, 88.0)	<0.001	74.5 (64.5, 80.0)	84.0 (80.0, 87.0)	<0.001
Fhypopnea, %	30.7 (12.2, 51.5)	71.9 (47.2, 87.7)	<0.001	38.6 (20.9, 55.6)	68.6 (38.1, 85.1)	<0.001
AT Score	24.4 (18.7, 32.0)	11.6 (9.0, 14.6)	<0.001	21.7 (17.2, 28.7)	12.2 (9.4, 15.1)	<0.001
Comorbidities
Hypertension, n (%)	584 (31.6)	403 (25.9)	<0.001	299 (31.9)	250 (26.7)	0.013
Diabetes, n (%)	141 (7.6)	105 (6.8)	0.323	79 (8.4)	55 (5.9)	0.031
CHD, n (%)	95 (5.1)	108 (6.9)	0.027	47 (5.0)	60 (6.4)	0.196
CVD, n (%)	70 (3.8)	79 (5.1)	0.067	30 (3.2)	41 (4.4)	0.183

Notes: Values were expressed as median (interquartile range in brackets) or count (percentage). T90%: cumulative percentages of time spent at arterial oxygen saturation below 90%; MSpO2: mean pulse oxygen saturation; LSaO2: lowest arterial oxygen saturation; WASO: wake after sleep onset; MAI: microarousal index; TST: total sleep time; N1%, N2%, N3%, REM%: the percentage of stage 1, 2, 3 and rapid eye movement sleep in total sleep time; F_hypopnea: fraction of the respiratory events that were hypopnea.

Abbreviations: AT, arousal threshold; PSM, propensity score matching; BMI, body mass index; NC, neck circumstance; WC, waist circumstance; PSG, polysomnography; AHI, apnea–hypopnea index; ODI, oxygen desaturation index. CHD, coronary heart disease; CVD, cerebrovascular disease.

Table 2 The Relationship Between High at and the Occurrence of Hypertension, Diabetes, CHD and CVD in Patients with OSA Before and After PSM, Compared with Low AT

	Before PSM		After PSM
	Unadjusted OR (95% CI)	Adjusted OR (95% CI)	Unadjusted OR (95% CI)	Adjusted OR (95% CI)
Hypertension	1.32 (1.14–1.54)**	1.36 (1.14–1.62**	1.29 (1.06–1.57)*	1.31 (1.07–1.62)**
Diabetes	1.14 (0.88–1.48)	1.23 (0.91–1.65)	1.48 (1.03–2.11)*	1.45 (1.01–2.08)*

Notes: The adjusted ORs for various comorbidities were adjusted by age, BMI, male%, smoking, ODI and T90%. alcohol consumption. Bolded numbers indicated the results were statistically significant, * indicated P value <0.05, and ** indicated P value <0.01.

Abbreviations: AT, arousal threshold; PSM, propensity score matching; OR, odds ratio; CI, confidence interval.

Table 3 The Relationship Between the Different Threshold of AT Score, AHI and the Occurrence of Hypertension in Patients with OSA (After PSM)

Predictors/Threshold for the Risk of Hypertension	n	Adjusted OR (95% CI)
		Model 1	Model 2
AT score
AT score ≤ 15	810	Ref	Ref
15 ≤ AT score < 30	852	1.29 (1.03–1.62)*	1.31 (1.04–1.64)*
30 ≤ AT score	214	1.45 (1.02–2.06)*	1.47 (1.02–2.10)*
AHI
5 ≤ AHI < 15	592	Ref	Ref
15 ≤ AHI < 30	603	1.11 (0.85–1.44)	1.11 (0.85–1.44)
AHI ≥ 30	681	1.34 (1.04–1.73)*	1.35 (1.04–1.74)*

Notes: Low AT score and low AHI were considered as the reference. Model 1 was adjusted for age, BMI, male%, smoking, alcohol consumption; Model 2: Model 1 + ODI and T90%. Bolded numbers indicated the results were statistically significant, and * indicated P value <0.05.

Abbreviation: AT, arousal threshold; AHI, apnea hypopnea index; OSA, obstructive sleep apnea; PSM, propensity score matching; OR, odds ratio; CI, confidence interval.

Table 4 The Relationship Between the Different Threshold of AT Score, AHI and the Occurrence of Diabetes in Patients with OSA (After PSM)

Predictors/Threshold for the Risk of Diabetes	n	Adjusted OR (95% CI)
		Model 1	Model 2
AT score
AT score ≤ 15	810	Ref	Ref
15 ≤ AT score < 30	852	1.05 (0.70–1.57)	1.07 (0.67–1.51)
30 ≤ AT score	214	1.90 (1.11–3.27)*	1.79 (1.02–3.13)*
AHI
5 ≤ AHI < 15	592	Ref	Ref
15 ≤ AHI < 30	603	1.10 (0.69–1.76)	1.09 (0.68–1.75)
AHI ≥ 30	681	1.29 (0.83–2.00)	1.23 (0.79–1.93)

Notes: Low AT score and low AHI were considered as the reference. Model 1 was adjusted for age, BMI, male%, smoking, alcohol consumption; Model 2: Model 1 + ODI and T90%.; Bolded numbers indicated the results were statistically significant, and *indicated P value <0.05.

Abbreviations: AT, arousal threshold; AHI, apnea hypopnea index; OSA, obstructive sleep apnea; PSM, propensity score matching; OR, odds ratio; CI, confidence interval.

Data Sharing Statement

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