Background
Methods
Study participants
Polysomnography
Assessments
Statistical analysis
Results
Participant characteristics
Index | |
Clinical background | |
Age, years | 56 ± 11 |
Sex, male/female, n | 74/22 |
BMI, kg/m2 | 27.6 ± 4.2 |
Abdominal circumference, cm | 94.8 ± 20.7 |
Smoking, current/others, n | 21/75 |
Sleep parameters | |
AHI, events/h | 36.5 ± 20.7 |
CT90, % | 13.1 ± 18 |
Lowest oxygen saturation, % | 78.9 ± 8.3 |
3% ODI, events/h | 35.3 ± 20.5 |
Arousal index, events/h | 34.4 ± 17.8 |
OSA, mild/moderate/severea, n | 12/31/53 |
Comorbidities | |
Diabetes mellitus, +/−, n | 26/70 |
Insulin use, +/−, n | 5/91 |
Hypertension, +/−, n | 58/38 |
Hypertension (self-reported), +/−, n | 65/31 |
Dyslipidemia, +/−, n | 62/34 |
Albuminuriab, macro/micro/−, n | 2/12/82 |
Chronic obstructive pulmonary disease, +/−, n | 2/94 |
Asthma, +/−, n | 4/92 |
Allergic rhinitis, +/−, n | 16/80 |
Blood/Urine tests | |
Total cholesterol, mg/dL | 196 ± 34 |
High-density lipoprotein, mg/dL | 53 ± 15 |
Low-density lipoprotein, mg/dL | 117 ± 30 |
Triglycerides, mg/dL | 172 ± 121 |
Free fatty acids, mg/dL | 490 ± 160 |
Blood glucose, mg/dL | 101 ± 24 |
Hemoglobin A1c, % | 6.2 ± 0.9 |
Insulin, μU/mL | 10.7 ± 10.2 |
Serum periostin, ng/mL | 67.3 ± 22.8 |
Urinary albumin–creatinine ratioc, mg/g | 25.4 ± 107.1 |
Associations between serum periostin level and clinical variables in OSA: BMI, disease severity, sleep metrics, and other clinical indices
Index | Estimate for serum periostina (95% CI) | p − value |
---|---|---|
Age, years | 3.9 × 10−3 (1.3 × × 10−3–6.6 × 10− 3) | < 0.01 |
BMI, kg/m2 | −6.9 × 10− 3 (−14 × 10− 3–0.2 × 10− 3) | 0.055 |
AHI, event/h | 0.2 × 10− 3 (− 1.3 × 10− 3–1.6 × 10− 3) | 0.82 |
CT90, % | −0.2 × 10− 3 (− 1.9 × 10− 3–1.4 × 10− 3) | 0.73 |
Lowest oxygen saturation, % | 2 × 10− 4 (− 3.4 × 10− 3–3.8 × 103) | 0.91 |
3% ODI, event/h | 6.5 × 10− 5 (− 1.4 × 10− 3–1.5 × 10− 3) | 0.92 |
Arousal index, event/h | 3.8 × 10− 4 (− 1.3 × 10− 3–0.002) | 0.66 |
Total cholesterol, mg/dL | −0.6 × 10−3 (− 1.5 × 10− 3–0.3 × 10− 3) | 0.19 |
High-density lipoprotein, mg/dL | 0.6 × 10− 3 (− 1.4 × 10− 3–2.7 × 10− 3) | 0.53 |
Low-density lipoprotein, mg/dL | −0.3 × 10− 3 (− 1.3 × 10− 3–0.6 × 10− 3) | 0.49 |
Triglycerides, mg/dL | −0.2 × 10− 3 (− 0.4 × 10− 3–0.09 × 10− 3) | 0.22 |
Free fatty acids, mg/dL | 0.09 × 10− 3 (− 0.1 × 10− 3–0.3 × 10− 3) | 0.37 |
Blood glucose, mg/dL | 1.6 × 10− 3 (0.4 × 10− 3–2.8 × 10− 3) | < 0.01 |
Hemoglobin A1c, % | 35.3 × 10− 3 (1.8 × 10− 3–68.8 × 10− 3) | 0.04 |
Urinary albumin–creatinine ratiob, mg/g | 1.61 × 10− 5 (− 26.3 × 10− 5–29.6 × 10− 5) | 0.91 |
Cluster analysis and comparative analysis in patients with severe OSA
Index | Cluster (n) | p-value | ||||
---|---|---|---|---|---|---|
1 (6) | 2 (30) | 3 (52) | 4 (8) | All cluster | 3 vs. 4 | |
Age, years | 47 ± 9 | 63 ± 9 | 59 ± 12 | 63 ± 8 | 0.01 | 0.33 |
Sex, male/female, n | 6/0 | 23/7 | 40/12 | 5/3 | 0.43 | 0.38 |
Smoking, current/others, n | 3/3 | 9/21 | 7/45 | 2/6 | 0.11 | 0.39 |
BMI, kg/m2 | 29.6 ± 2 | 27.1 ± 3.1 | 27.4 ± 4.6 | 30 ± 5.2 | 0.26 | 0.24 |
AHI, events/h | 33 ± 33 | 29 ± 17 | 39 ± 20 | 51 ± 18 | < 0.01 | 0.08 |
Severity of OSAa, mild–moderate/severe, n | 5/1 | 22/8 | 15/37 | 1/7 | < 0.01 | 0.33 |
CT90, % | 12.7 ± 25.3 | 13.3 ± 19.1 | 12.3 ± 16.4 | 18.5 ± 21.1 | 0.85 | 0.22 |
Lowest oxygen saturation, % | 76.5 ± 12.5 | 80.5 ± 7.3 | 79.2 ± 8.0 | 73.3 ± 9.5 | 0.14 | 0.1 |
3% ODI, events/h | 31.2 ± 33.8 | 28.2 ± 17.3 | 35.6 ± 19.6 | 50.6 ± 19.7 | 0.04 | 0.06 |
High ODIb, +/−, n | 1/5 | 9/21 | 31/21 | 7/1 | < 0.01 | 0.13 |
Arousal index, events/h | 21.5 ± 10.9 | 29.4 ± 13.9 | 40.6 ± 19.4 | 37.8 ± 19.1 | 0.03 | 0.66 |
Serum periostin, ng/mL | 48.2 ± 14.7 | 67.1 ± 19.7 | 66.5 ± 21.8 | 87.1 ± 32.3 | 0.04 | 0.05 |
Serum periostin, high/lowc, n | 0/6 | 7/23 | 8/44 | 4/4 | 0.07 | 0.02 |
Blood eosinophils, /μL | 204 (99–334) | 202 (159–355) | 225 (124–317) | 245 (165–288) | 0.86 | 0.68 |
Total cholesterol, mg/dL | 228 ± 39 | 186 ± 32 | 195 ± 31 | 215 ± 41 | 0.03 | 0.11 |
High-density lipoprotein, mg/dL | 44 ± 10 | 52 ± 13 | 55 ± 16 | 53 ± 14 | 0.27 | 0.69 |
Low-density lipoprotein, mg/dL | 155 ± 33 | 107 ± 34 | 117 ± 25 | 126 ± 20 | < 0.01 | 0.36 |
Triglycerides, mg/dL | 190 ± 74 | 177 ± 75 | 152 ± 110 | 263 ± 266 | 0.05 | 0.04 |
Free fatty acids, mg/dL | 409 ± 103 | 535 ± 177 | 460 ± 147 | 577 ± 151 | 0.03 | 0.04 |
Blood glucose, mg/dL | 96 ± 14 | 112 ± 26 | 92 ± 11 | 130 ± 45 | < 0.01 | < 0.01 |
Hemoglobin A1c, % | 5.8 ± 0.4 | 6.8 ± 1.0 | 5.8 ± 0.4 | 7.2 ± 1.1 | < 0.01 | < 0.01 |
Dyslipidemia, +/−, n | 5/1 | 26/4 | 26/26 | 5/3 | < 0.01 | 0.16 |
Diabetes mellitus, +/−, n | 0/6 | 21/9 | 0/52 | 5/3 | < 0.01 | < 0.01 |
Hypertension, +/−, n | 2/4 | 25/5 | 24/28 | 7/1 | < 0.01 | 0.03 |
Urinary albumin–creatinine ratiod, mg/g | 30.5 ± 5.5 | 6.4 ± 3.7 | 4.7 ± 2.7 | 228.3 ± 322.3 | < 0.01 | < 0.01 |
Albuminuriae, macro/micro/−, n | 0/6/0 | 0/0/30 | 0/0/52 | 2/6/0 | < 0.01 | < 0.01 |
History of coronary artery disease, +/−, n | 0/6 | 2/28 | 4/48 | 0/8 | 0.77 | 0.42 |
History of stroke, +/−, n | 1/5 | 0/30 | 3/49 | 1/7 | 0.25 | 0.48 |
Chronic obstructive pulmonary disease, +/−, n | 0/6 | 1/29 | 1/51 | 0/8 | 0.91 | 0.69 |
Asthma, +/−, n | 1/5 | 0/30 | 1/51 | 2/6 | < 0.01 | 0.01 |
Allergic rhinitis, +/−, n | 0/6 | 4/26 | 11/41 | 1/7 | 0.51 | 0.57 |
Index | Mild/moderate OSAan = 43 | Severe OSAa alone n = 41 n = 41 | Severe OSAa + high periostinb n = 12 | p-value‡ |
---|---|---|---|---|
Age, years | 60 ± 10 | 58 ± 12 | 63 ± 9 | 0.16 |
Sex, male/female, n | 33/10 | 31/10 | 10/2 | 0.57 |
Smoking, current/others, n | 12/31 | 8/33 | 1/11 | 0.36 |
BMI, kg/m2 | 26.2 ± 3.5 | 28.9 ± 4.6 | 28.6 ± 3 | 0.83 |
AHI, events/h | 18.8 ± 6.9 | 51.1 ± 17.5 | 50 ± 13.5 | 0.90 |
CT90, % | 5.5 ± 8.0 | 21 ± 22.7 | 13.8 ± 14.8 | 0.59 |
3% ODI, events/h | 17.5 ± 7.3 | 48.5 ± 18.6 | 46.1 ± 13.4 | 0.83 |
Lowest oxygen saturation, % | 82.6 ± 7.6 | 76 ± 7.5 | 75.6 ± 8.4 | 0.98 |
Arousal index, events/h | 21.8 ± 8.8 | 45.4 ± 17.8 | 41.8 ± 12.6 | 0.51 |
Serum periostin, ng/mL | 64.7 ± 22.4 | 59.7 ± 13.9 | 102.7 ± 15.4 | – |
Blood eosinophils, /μL | 202 (124–350) | 219 (131–299) | 240 (155–284) | 0.92 |
Total cholesterol, mg/dL | 195 ± 32 | 199 ± 37 | 189 ± 32 | 0.40 |
High-density lipoprotein, mg/dL | 55 ± 16 | 53 ± 13 | 48 ± 15 | 0.30 |
Low-density lipoprotein, mg/dL | 114 ± 34 | 121 ± 28 | 111 ± 21 | 0.22 |
Triglycerides, mg/dL | 158 ± 90 | 175 ± 148 | 207 ± 117 | 0.49 |
Free fatty acids, mg/dL | 480 ± 172 | 474 ± 147 | 581 ± 139 | 0.03 |
Blood glucose, mg/dL | 100 ± 23 | 100 ± 23 | 113 ± 33 | 0.12 |
Hemoglobin A1c, % | 6.2 ± 0.9 | 6.1 ± 0.8 | 6.5 ± 1.1 | 0.19 |
Dyslipidemia, +/−, n | 15/28 | 16/25 | 7/5 | 0.24 |
Diabetes mellitus, +/−, n | 14/29 | 7/34 | 5/7 | 0.07 |
Hypertension, +/−, n | 22/21 | 29/12 | 8/4 | 0.79 |
Urinary albumin–creatinine ratioc, mg/g | 10.5 ± 15.9 | 22.5 ± 89.4 | 89.4 ± 258.5 | 0.31 |
Albuminuriad, macro/micro/−, n | 0/6/37 | 1/3/37 | 1/3/8 | 0.04e |
Chronic obstructive pulmonary disease, +/−, n | 1/41 | 0/41 | 1/11 | 0.06 |
Asthma, +/−, n | 1/42 | 1/40 | 2/10 | 0.06 |
Allergic rhinitis, +/−, n | 8/35 | 6/35 | 2/10 | 0.89 |
Responsiveness to CPAP treatment in patients with severe OSA
Index | Severe OSAa alone (n = 35) | Severe + high periostinb (n = 8) | ||||
---|---|---|---|---|---|---|
Baseline | 3 M after CPAP | p-value | Baseline | 3 M after CPAP | p-value | |
BMI, kg/m2 | 28.7 ± 4.8 | 28.9 ± 4.5 | 0.47 | 28.2 ± 3.5 | 28.6 ± 3.4 | 0.18 |
AHI, events/h | 52.3 ± 18 | 3.4 ± 3.8 | < 0.01 | 51.3 ± 15.9 | 5.1 ± 4.5 | < 0.01 |
CT90, % | 22.4 ± 23.7 | 0.2 ± 0.8 | < 0.01 | 14 ± 6 | 0.7 ± 1.3 | 0.05 |
3% ODI, events/h | 50.1 ± 19.5 | 2.8 ± 3.6 | < 0.01 | 46.5 ± 16 | 4.5 ± 4.3 | < 0.01 |
Arousal index, events/h | 50 ± 17.7 | 18.9 ± 6.8 | < 0.01 | 43.7 ± 14 | 20.2 ± 8.5 | < 0.01 |
Lowest oxygen saturation, % | 75.5 ± 7.8 | 91.1 ± 4.1 | < 0.01 | 72.9 ± 8.5 | 89.5 ± 3.3 | < 0.01 |
Serum periostin, ng/mL | 60.1 ± 14 | 61.8 ± 15.5 | 0.38 | 104.1 ± 15.8 | 94 ± 10.8 | 0.04 |
Total cholesterol, mg/dL | 199 ± 39 | 193 ± 38 | 0.21 | 201 ± 27 | 203 ± 29 | 0.58 |
High-density lipoprotein, mg/dL | 52 ± 14 | 52 ± 12 | 0.92 | 53 ± 14 | 56 ± 15 | 0.05 |
Low-density lipoprotein, mg/dL | 122 ± 29 | 119 ± 31 | 0.48 | 118 ± 19 | 123 ± 19 | 0.27 |
Triglycerides, mg/dL | 179 ± 159 | 153 ± 95 | 0.12 | 204 ± 122 | 207 ± 95 | 0.79 |
Free fatty acids, mg/dL | 464 ± 145 | 457 ± 171 | 0.81 | 609 ± 106 | 515 ± 116 | 0.25 |
Blood glucose, mg/dL | 99 ± 23 | 96 ± 18 | 0.64 | 120 ± 37 | 101 ± 17 | 0.66 |
Hemoglobin A1c, % | 6.1 ± 0.8 | 6.0 ± 0.7 | 0.62 | 6.8 ± 1.2 | 6.2 ± 0.6 | 0.26 |
Albuminuriac, macro/micro/−, n | 1/3/31 | 0/8/27 | 0.16e | 1/3/4 | 1/2/5 | 0.32e |
Urinary albumin–creatinine ratiod, mg/g | 25.6 ± 96.6 | 12.7 ± 34.2 | < 0.01 | 132.1 ± 306.5 | 60.6 ± 121 | < 0.01 |
Average CPAP use, min/day | 304 ± 78 | – | 385 ± 70 | 0.01f | ||
Percent days of CPAP use > 4 h, % | 65 ± 29 | – | 75 ± 24 | 0.36f |