Air pollution exacerbates mild obstructive sleep apnea by disrupting nocturnal changes in lower-limb body composition: a cross-sectional study conducted in urban northern Taiwan

Yansu He; Wen-Te Liu; Shang-Yang Lin; Zhiyuan Li; Hong Qiu; Steve Hung-Lam Yim; Hsiao-Chi Chuang; Kin Fai Ho

doi:10.1016/j.scitotenv.2023.163969

Air pollution exacerbates mild obstructive sleep apnea by disrupting nocturnal changes in lower-limb body composition: a cross-sectional study conducted in urban northern Taiwan

Sci Total Environ. 2023 Aug 20:887:163969. doi: 10.1016/j.scitotenv.2023.163969. Epub 2023 May 9.

Authors

Yansu He¹, Wen-Te Liu², Shang-Yang Lin³, Zhiyuan Li⁴, Hong Qiu¹, Steve Hung-Lam Yim⁵, Hsiao-Chi Chuang⁶, Kin Fai Ho⁷

Affiliations

¹ JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
² Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.
³ Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁴ Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, Hong Kong, China.
⁵ The Asian School of the Environment, Nanyang Technological University, Singapore.
⁶ School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
⁷ JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, Hong Kong, China. Electronic address: kfho@cuhk.edu.hk.

PMID: 37164092
DOI: 10.1016/j.scitotenv.2023.163969

Abstract

Background: Few studies have explored the role of body composition linking air pollution to obstructive sleep apnea (OSA).

Objective: To estimate the effects of air pollution on body composition and OSA, and that of body composition on OSA.

Methods: This study included 3550 individuals. A spatiotemporal model estimated personal exposure. Nocturnal changes in body composition were assessed through bioelectric impedance analysis. OSA was diagnosed using polysomnography. A generalized linear model was used to evaluate the absolute nocturnal changes in body composition associated with an interquartile range (IQR) increase in pollutants. A generalized logistic model was used to estimate odds ratios (ORs) of mild-OSA compared to non-OSA. Association between body composition and apnea-hypopnea index (AHI) was investigated through partial least squares (PLS) regression.

Results: Nocturnal changes in lower-limb body composition were associated with NO₂ and PM_2.5 in all patients. In participants with AHI <15, both short- and long-term NO₂ exposures affected body composition and mild-OSA, while PM_2.5 was not associated with either outcome. In a PLS model incorporating eight NO₂-associated lower-limb parameters, the variable importance projection scores (VIP) of left leg impedance (LLIMP), predicted muscle mass (LLPMM), fat-free mass (LLFFM), and right leg impedance (RLIMP) exceeded 1; the corresponding coefficients ranked in the top four for AHI prediction. The adjusted OR (mild vs. non-OSA) was 1.67 (95 % CI: 1.36-2.03) associated with an IQR increase in prediction value estimated from body compositions. Notably, the two-pollutant model investigating the effects of pollutants on body compositions revealed associations of four parameters (LLIMP, LLPMM, LLFFM, and RLIMP) with NO₂ in all lags, which indicates their indispensability in the association between NO₂ and AHI.

Conclusions: NO₂ exacerbates mild-OSA by disrupting nocturnal changes in lower-limb body composition of patients with AHI <15. PM_2.5 was associated with nocturnal changes in lower-limb body composition but not with mild-OSA.

Keywords: Bioelectric impedance analysis; Nocturnal changes in body composition; Partial least squares regression; Polysomnography; Spatiotemporal model.

MeSH terms

Air Pollution*
Body Composition
Cross-Sectional Studies
Environmental Pollutants*
Humans
Nitrogen Dioxide
Sleep Apnea, Obstructive*
Taiwan

Substances

Nitrogen Dioxide
Environmental Pollutants