The Impact of Glycolipid Metabolic Disorders on Severity Stage-Specific Variation of Cardiac Autonomic Function in Obstructive Sleep Apnea: A Data-Driven Clinical Study

Xiaolong Zhao; Huajun Xu; Chuan Dong; Jiangang Fan; Gang He; Jianyin Zou; Lili Meng; Huaming Zhu; Kaiming Su; Mingpo Yang; Hongliang Yi; Jian Wang; Shankai Yin; Jian Guan

doi:10.2147/NSS.S317201

The Impact of Glycolipid Metabolic Disorders on Severity Stage-Specific Variation of Cardiac Autonomic Function in Obstructive Sleep Apnea: A Data-Driven Clinical Study

Nat Sci Sleep. 2021 Jul 28:13:1347-1362. doi: 10.2147/NSS.S317201. eCollection 2021.

Authors

Xiaolong Zhao^#^{1

2

3}, Huajun Xu^#^{1

3}, Chuan Dong^#², Jiangang Fan², Gang He², Jianyin Zou^{1

3}, Lili Meng^{1

3}, Huaming Zhu^{1

3}, Kaiming Su^{1

3}, Mingpo Yang⁴, Hongliang Yi^{1

3}, Jian Wang⁵, Shankai Yin^{1

3}, Jian Guan^{1

3}

Affiliations

¹ Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.
² Department of Otolaryngology Head and Neck Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, People's Republic of China.
³ Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, People's Republic of China.
⁴ Institute of Neuroscience, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, People's Republic of China.
⁵ School of Communication Science and Disorders/Physiol & Biophysics, Dalhousie University, Halifax, NS, Canada.

^# Contributed equally.

Abstract

Background: Cardiac autonomic dysfunction (CAD) is a common pathology in cardiovascular diseases; however, the role of glycolipid metabolic disorders in CAD development in obstructive sleep apnea (OSA) remains poorly understood.

Methods: In total, 4152 patients with suspected OSA were recruited in our sleep center. Metabolic characteristics including anthropometric and glycolipid data were collected. Heart rate variability (HRV) was measured to assess the risk of CAD; its dose-response relationship with OSA severity was evaluated via restricted cubic spline (RCS) analysis. A segmented multivariate linear regression (SMLR) model was used to evaluate the roles of metabolic variables in different stages of OSA.

Results: The RCS showed that CAD risk increased in a nonlinear relationship pattern with OSA severity, from slow fluctuation at earlier stages to rapid change in later stages. After integrating the clinical definition and RCS selected knots, we obtained the new four OSA severity stages. SMLR model showed that the overall value of glycolipid variables for prediction of HRV abnormalities was greater than the value of OSA variables at earlier stages, while OSA variables were more effective predictors in more severe stages. The discordance in respective relationship of HRV with metabolic and OSA variables sheds the light how metabolic disorders promoted the development of CAD in OSA, the later further in turn deteriorates cardiac function.

Conclusion: These results are indicative of stage-specific involvement of glycolipid metabolic factors underlying CAD nonlinear changes in patients with OSA. Early control glycolipid disorders may help the control of CAD development in patients with OSA.

Keywords: autonomic nervous system; cardiac autonomic neuropathy; heart rate variability; metabolism; obstructive sleep apnea.

Grants and funding

This research was supported by National Natural Science Foundation of China (81700896, 81770987, 81701306, 81770988); Shanghai Municipal Commission of Science and Technology (Grant No.18DZ2260200); Innovation Program of Shanghai Municipal Education Commission (2017-01-07-00-02-E00047); multi-center clinical research project from school of medicine, Shanghai Jiao Tong University (DLY201502); the Open Research Project of Shanghai Key Laboratory of Sleep Disordered Breathing (SHKSDB-KF-20-03); Youth scientific research project of Sichuan provincial medical association (Q19018); Youth Fund of Sichuan Provincial People’s Hospital (2021QN03); Cadre health research project (2021-210).