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Alrahbeni T, Gupta JK, Alkhouri A, Kumar LA, Mahal A, Al-Mugheed K, Satapathy P, Kukreti N, Khatib MN, Gaidhane S, Gaidhane AM, Rustagi S, Mohanty D, Padhi BK. Association of air pollution with risk and severity of obstructive sleep apnea: A systematic review and meta-analysis. Neurotoxicology 2024; 102:106-113. [PMID: 38636605 DOI: 10.1016/j.neuro.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/10/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Obstructive Sleep Apnea (OSA) is a significant health concern characterized by recurrent upper airway blockages during sleep, causing various health issues. There's growing evidence of a link between air pollution and OSA, though research results have been inconsistent. This systematic review and meta-analysis aims to consolidate and examine data on the relationship between air pollution and OSA's risk and severity. METHODS A literature search across PubMed, EMBASE, and Web of Science was conducted until January 10, 2024. The selection criteria targeted studies involving OSA participants or those at risk, with quantitative air pollution assessments. The Nested Knowledge software facilitated screening and data extraction, while the Newcastle-Ottawa Scale was used for quality assessment. Meta-analyses, utilizing random-effects models, computed pooled odds ratios (ORs) for the OSA risk associated with PM2.5 and NO2 exposure, analyzed using R software version 4.3. RESULTS The systematic review included twelve studies, four of which were analyzed in the meta-analysis. The meta-analysis revealed diverse results on the association of PM2.5 and NO2 with OSA risk. PM2.5 exposure showed a pooled OR of 0.987 (95 % CI: 0.836-1.138), indicating no substantial overall impact on OSA risk. Conversely, NO2 exposure was linked to a pooled OR of 1.095 (95 % CI: 0.920-1.270), a non-significant increase in risk. Many studies found a relationship between air pollution exposure and elevated Apnea-Hypopnea Index (AHI) levels, indicating a relationship between air pollution and OSA severity. CONCLUSION The findings suggest air pollutants, especially NO2, might play a role in worsening OSA risk and severity, but the evidence isn't definitive. This highlights the variability of different pollutants' effects and the necessity for more research. Understanding these links is vital for shaping public health policies and clinical approaches to address OSA amidst high air pollution.
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Affiliation(s)
- Tahani Alrahbeni
- Molecular Toxicology and Genetics, Riyadh Elm University, Saudi Arabia
| | | | - Anas Alkhouri
- College of Pharmacy, Cihan University-Erbil, Erbil, Kurdistan Region, Iraq
| | - Ladi Alik Kumar
- Centurion University of Technology and Management, Odisha, India
| | - Ahmed Mahal
- Department of Medical Biochemical Analysis, College of Health Technology, Cihan University-Erbil, Erbil, Kurdistan Region, Iraq
| | - Khalid Al-Mugheed
- Adult Health Nursing and Critical Care, Riyadh Elm University, Saudi Arabia
| | - Prakasini Satapathy
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India; Medical Laboratories Techniques Department, Al-Mustaqbal University, Hillah, Babil 51001, Iraq
| | - Neelima Kukreti
- School of Pharmacy, Graphic Era Hill University, Dehradun, India
| | - Mahalaqua Nazli Khatib
- Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Shilpa Gaidhane
- One Health Centre (COHERD), Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education, Wardha, India
| | - Abhay M Gaidhane
- Jawaharlal Nehru Medical College, and Global Health Academy, School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education, Wardha, India
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun, Uttarakhand, India
| | - Dibyalochan Mohanty
- Centre for Nano Medicine, Department of Pharmaceutics, School of Pharmacy, Anurag University, Hyderabad, India
| | - Bijaya Kumar Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
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Wang H, Li J, Liu Q, Zhang Y, Wang Y, Li H, Sun L, Hu B, Zhang D, Liang C, Lei J, Wang P, Sheng J, Tao F, Chen G, Yang L. Physical activity attenuates the association of long-term exposure to nitrogen dioxide with sleep quality and its dimensions in Chinese rural older adults. J Affect Disord 2024; 349:187-196. [PMID: 38199389 DOI: 10.1016/j.jad.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/05/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Joint impacts of air pollution and physical activity (PA) on sleep quality remain unaddressed. We aimed to investigate whether PA attenuates the association of long-term exposure to nitrogen dioxide (NO2) with sleep quality and its dimensions in older adults. METHODS This study included 3408 Chinese rural older adults. Annual NO2 was estimated using the Space-Time Extra-Trees model. PA was assessed by International Physical Activity Questionnaire. Sleep quality was evaluated using Pittsburgh Sleep Quality Index (PSQI) scale. Linear regression models were used to assess the associations of long-term NO2 exposure and PA with sleep quality and its dimensions, and interaction plots were used to depict the attenuating effect of PA on associations of NO2 with sleep quality and its dimensions. RESULTS Three-year (3-y) average NO2 (per 0.64-μg/m3 increment) was positively associated with global PSQI (β = 0.41, 95 % CI: 0.23, 0.59), sleep duration (β = 0.16, 95 % CI: 0.11, 0.21), and habitual sleep efficiency (β = 0.22, 95 % CI: 0.17, 0.27), while PA was negatively associated with global PSQI (β = -0.33, 95 % CI: -0.46, -0.20) and five domains of PSQI other than sleep duration and sleep disturbances. The associations of NO2 with global PSQI, sleep duration, and habitual sleep efficiency were attenuated with increased PA (Pinteraction were 0.037, 0.020, and 0.079, respectively). CONCLUSIONS PA attenuates the adverse impacts of long-term NO2 exposure on sleep quality, especially on sleep duration, and habitual sleep efficiency, in Chinese rural elderly people. Participating in PA should be encouraged in this population, and continued efforts are still needed to reduce air pollution.
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Affiliation(s)
- Hongli Wang
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei 230032, Anhui, China; Center for Big Data and Population Health of IHM, Hefei 230032, Anhui, China
| | - Junzhe Li
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei 230032, Anhui, China; Center for Big Data and Population Health of IHM, Hefei 230032, Anhui, China
| | - Qiang Liu
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei 230032, Anhui, China; Center for Big Data and Population Health of IHM, Hefei 230032, Anhui, China
| | - Yan Zhang
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei 230032, Anhui, China
| | - Yuan Wang
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei 230032, Anhui, China
| | - Huaibiao Li
- Fuyang Center for Diseases Prevention and Control, Fuyang 236069, Anhui, China
| | - Liang Sun
- Fuyang Center for Diseases Prevention and Control, Fuyang 236069, Anhui, China
| | - Bing Hu
- Fuyang Center for Diseases Prevention and Control, Fuyang 236069, Anhui, China
| | - Dongmei Zhang
- School of Health Services Management, Anhui Medical University, Hefei 230032, Anhui, China
| | - Chunmei Liang
- School of Public Health, Department of Hygiene Inspection and Quarantine, Anhui Medical University, Hefei 230032, Anhui, China
| | - Jingyuan Lei
- School of Public Health, Department of Hygiene Inspection and Quarantine, Anhui Medical University, Hefei 230032, Anhui, China
| | - Panpan Wang
- School of Public Health, Department of Hygiene Inspection and Quarantine, Anhui Medical University, Hefei 230032, Anhui, China
| | - Jie Sheng
- Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China
| | - Fangbiao Tao
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, Anhui, China
| | - Guimei Chen
- School of Health Services Management, Anhui Medical University, Hefei 230032, Anhui, China
| | - Linsheng Yang
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Hefei 230032, Anhui, China; Center for Big Data and Population Health of IHM, Hefei 230032, Anhui, China.
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Duan X, Zhao W, Yang B, Lao L, Mei Y, Wu C, Liao Y, Wang Y, Feng Z, Chen W, Ge E, Deng H, Liu X. Association of residential greenness with obstructive sleep apnea among Chinese old adults and the mediation role of PM 2.5 and leisure-time physical activity. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 915:170120. [PMID: 38232829 DOI: 10.1016/j.scitotenv.2024.170120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 01/19/2024]
Abstract
Few studies have investigated the association of residential greenness with obstructive sleep apnea (OSA). This study was to comprehensively examine the association of residential greenness exposure with OSA and explore the mediating effect of leisure-time physical activity (LTPA) and PM2.5 on the association among Chinese old adults. A prospective cohort study that enrolled 2027 adults aged ≥65 was conducted between 1st July 2015 and 30th September 2019 in Southern China. OSA was ascertained by Berlin Questionnaire. Greenness exposure was measured by contemporaneous and cumulative average normalized difference vegetation index (NDVI) in the 1000 m radius around each participant's residential address. Hazard ratios (HRs) with 95 % confidence intervals (CIs) were calculated by Cox proportional hazards model to assess the impact of greenness exposure on the incidence of OSA after adjusting for confounders. LTPA and PM2.5 were examined as potential mediators in the aforementioned models. A total of 293, nearly 14.5 %, participants developed OSA within 59,251 person-months of follow-up. When comparing the highest with lowest tertiles, both contemporaneous NDVI (>0.351 vs. ≤0.325: HR = 0.20, 95 % CI = 0.13-0.31) and cumulative NDVI (> 0.346 vs. ≤ 0.317: HR = 0.32, 95 % CI = 0.21-0.47) were associated with a reduced risk of OSA after adjusting for confounders. LTPA and PM2.5 significantly mediated the association between greenness and OSA. In conclusion, this study indicated that exposure to higher residential greenness could decrease OSA risk, and this benefit may be achieved by promoting physical activity and decreasing PM2.5 concentration. The findings suggest to formulate targeted interventional strategies by expanding residential greenness to prevent OSA and reduce disease burden.
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Affiliation(s)
- Xueru Duan
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China; Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wenjing Zhao
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
| | - Boyi Yang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Lixian Lao
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Yunting Mei
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Chuchu Wu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yifu Liao
- Department of Neurology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Yongqi Wang
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Zuyi Feng
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Weiqing Chen
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, China
| | - Erjia Ge
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Hai Deng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China.
| | - Xudong Liu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China.
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Fang T, Gu Y, Yim SHL. Assessing local and transboundary fine particulate matter pollution and sectoral contributions in Southeast Asia during haze months of 2015-2019. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 912:169051. [PMID: 38061644 DOI: 10.1016/j.scitotenv.2023.169051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 01/18/2024]
Abstract
While previous studies have investigated haze events over Southeast Asia (SEA), local and transboundary contributions of various emission sources to haze months over the entire SEA have yet to be assessed comprehensively and systematically. We utilized the Particle Source Apportionment Technique (PSAT) to quantify the spatial local, transboundary, and sectoral contributions to PM2.5 over SEA during the haze months of 2015-2019. Results show that local emission contributions accounted for 56.1 % ~ 94.2 % of PM2.5 in Indonesia, Philippines, Vietnam, and Thailand. Transboundary contributions (23.1 % ~ 57.6 %) from Indonesia notably influenced maritime SEA. Vietnam (15.6 % ~ 39.1 %) and super-regional (17.0 % ~ 34.3 %) contributions outside the SEA exerted remarkable impacts on mainland SEA. Among different sectors, fire emissions contributed the most to PM2.5 over maritime SEA (23.0 % ~ 68.6 %) during the studied haze months, whereas residential and other emissions were the main contributors to mainland SEA (27.2 % ~ 36.7 %). Regarding the source species, primary PM2.5 accounted for the majority of PM2.5. VOC and SO2 composed most of the secondary PM2.5 due to massive VOC emissions in the region and the priority reaction of NH3 with sulfuric acid (H2SO4) to form ammonium sulfate. Besides, the intensified haze months in Oct 2015 and Sep 2019 were characterized by more intensive fire emissions in the region and the climatic variability-induced meteorological effects that provided favorable condition for transboundary air pollution (56.9 % and 44.9 %, respectively, for maritime SEA, as well as 46.0 % and 37.7 %, respectively, for mainland SEA in the two studied haze months). The haze months can be attributed to the notable drought conditions amidst global climatic phenomena such as El Niño and positive Indian Ocean Dipole (IOD) in Oct 2015 and Sep 2019, respectively.
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Affiliation(s)
- Tingting Fang
- Earth Observatory of Singapore, Nanyang Technological University, Singapore 639798, Singapore
| | - Yefu Gu
- Department of Geography and Resource Management, The Chinese University of Hong Kong, Sha Tin 999077, Hong Kong, China
| | - Steve H L Yim
- Earth Observatory of Singapore, Nanyang Technological University, Singapore 639798, Singapore; Asian School of the Environment, Nanyang Technological University, Singapore 639798, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 639798, Singapore.
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He Y, Liu WT, Lin S, Li Z, Qiu H, Yim SHL, Chuang HC, Ho KF. The joint association of ambient air pollution and different sleep posture with mild obstructive sleep apnea: A study conducted at Taipei Sleep Center. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 903:166531. [PMID: 37633386 DOI: 10.1016/j.scitotenv.2023.166531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/02/2023] [Accepted: 08/22/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Growing evidence suggests the detrimental impact of supine position and air pollution on obstructive sleep apnea (OSA), as well as the potential benefits of nonsupine positions. However, their interaction effects on OSA remain unclear. OBJECTIVES To evaluate the interaction effects of air pollution (NO2/PM2.5) and sleep position on OSA on additive and multiplicative scales. METHODS This study included 3330 individuals. Personal exposure to air pollution was assessed using a spatiotemporal model. OSA was diagnosed through polysomnography. The associations of supine and nonsupine positions and air pollutants with mild-OSA and their interaction effects on mild-OSA. were explored through generalized logistic regression. RESULTS Supine position and high NO2 level independently increased the risk of mild-OSA, while PM2.5 was not associated with mild-OSA. Significant interactions were observed between supine position and NO2 at different lag periods (0-7 days, 0-1 year, and 0-2 years) (P = 0.042, 0.013, and 0.010, respectively). The relative excess risks due to interactions on the additive scale for 1-week, 1-year, and 2-year NO2 exposure and supine position were 0.63 (95 % CI: 0.10-1.16), 0.56 (95 % CI: 0.13-0.99), and 0.64 (95 % CI: 0.18-1.10); the corresponding odds ratios for interactions on the multiplicative scale were 1.45 (95 % CI: 1.01-2.07), 1.55 (95 % CI: 1.09-2.22), and 1.60 (95 % CI: 1.12-2.28). The positive interactions persisted in men and participants with obesity. No interaction was observed between nonsupine position and NO2 levels; nevertheless, significant interactions were noted on both the negative additive and multiplicative scales in men. CONCLUSION Prolonged supine sleep significantly increased the risk of mild-OSA, particularly in men and individuals with obesity. Although the benefits of nonsupine position are considerably less than the risks of NO2 exposure, avoiding prolonged supine sleep may reduce the risk of mild-OSA caused by high levels of NO2 in men.
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Affiliation(s)
- Yansu He
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, HKSAR, China
| | - Wen-Te Liu
- 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
| | - Shangyang Lin
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Zhiyuan Li
- Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, HKSAR, China
| | - Hong Qiu
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, HKSAR, China
| | - Steve Hung Lam Yim
- The Asian School of the Environment, Nanyang Technological University, Singapore
| | - Hsiao-Chi Chuang
- 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
| | - Kin Fai Ho
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, HKSAR, China; Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, HKSAR, China.
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Zhang Q, Wang H, Zhu X, Li A, Liu C, Guo Y, Kan H, Chen R. Air pollution may increase the sleep apnea severity: A nationwide analysis of smart device-based monitoring. Innovation (N Y) 2023; 4:100528. [PMID: 38028136 PMCID: PMC10654035 DOI: 10.1016/j.xinn.2023.100528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Obstructive sleep apnea (OSA) can lead to sleep deprivation, accidents, and cardiovascular diseases. However, research on the short-term effects of air pollutants on OSA severity is limited and inconsistent. We conducted a novel case time series analysis using a nationwide dataset among Huawei smart device users to assess the association between air pollution and OSA severity in a population at moderate-to-severe risk of OSA. Fixed-effects regression models were used to assess the associations between air pollution and the risk of OSA exacerbation, apnea-hypopnea index (AHI), and oxygen saturation. A total of 51,842 participants who were at moderate-to-severe risk of OSA (mean age [SD]: 45.4 [11.0], 95.5% male) were included, with 6,232,056 person-days of monitoring. The associations of fine particulate matter, nitrogen dioxide, carbon monoxide, and sulfur dioxide with OSA severity could occur during the sleep period, and last for 2 days. An increase of 1 interquartile range in the moving average concentrations of air pollution during the sleep period and the 2 previous days was associated with a 1.14%-4.31% increase in the risk of OSA exacerbation, an increase in AHI by 0.05-0.17 events/h, and a decrease in oxygen saturation (%) by 0.003-0.014. The exposure-response curves were almost linear. The associations between air pollutants and OSA were consistently stronger in participants aged 45 years or older. By virtue of the smart device-based technology, this large-scale, nationwide, longitudinal study provides compelling evidence that short-term exposure to air pollution may worsen sleep apnea. Our findings highlight the significance of ongoing efforts to improve air quality in mitigating OSA severity and the relevant disease burden in an aging era.
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Affiliation(s)
- Qingli Zhang
- School of Public Health, Shanghai Institute of Infectious Disease and Biosecurity, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China
- Ministry of Education - Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Hong Wang
- Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
| | - Xinlei Zhu
- School of Public Health, Shanghai Institute of Infectious Disease and Biosecurity, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Anni Li
- School of Public Health, Shanghai Institute of Infectious Disease and Biosecurity, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Cong Liu
- School of Public Health, Shanghai Institute of Infectious Disease and Biosecurity, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Yutao Guo
- Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
- Chinese PLA Medical College, Beijing 100039, China
| | - Haidong Kan
- School of Public Health, Shanghai Institute of Infectious Disease and Biosecurity, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China
- Shanghai Institute of Pollution Control and Ecological Security, Shanghai 200092, China
| | - Renjie Chen
- School of Public Health, Shanghai Institute of Infectious Disease and Biosecurity, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China
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Tsai CY, Liu M, Huang HT, Hsu WH, Kuan YC, Majumdar A, Lee KY, Feng PH, Tseng CH, Chen KY, Kang JH, Lee HC, Wu CJ, Liu WT. Association between air pollutant exposure, body water distribution and sleep disorder indices in individuals with low-arousal-threshold obstructive sleep apnoea. BMJ Open Respir Res 2023; 10:e001802. [PMID: 37940353 PMCID: PMC10632889 DOI: 10.1136/bmjresp-2023-001802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Air pollution may alter body water distribution, it may also be linked to low-arousal-threshold obstructive sleep apnoea (low-ArTH OSA). Here, we explored the mediation effects of air pollution on body water distribution and low-ArTH OSA manifestations. METHODS In this retrospective study, we obtained sleep centre data from healthy participants and patients with low-ArTH OSA (N=1924) in northern Taiwan. Air pollutant exposure at different time intervals (1, 3, 6 and 12 months) was estimated using the nearest station estimation method, and government air-quality data were also obtained. Regression models were used to assess the associations of estimated exposure, sleep disorder indices and body water distribution with the risk of low-ArTH OSA. Mediation analysis was performed to explore the relationships between air pollution, body water distribution and sleep disorder indices. RESULTS First, exposure to particulate matter (PM) with a diameter of ≤10 µm (PM10) for 1 and 3 months and exposure to PM with a diameter of ≤2.5 µm (PM2.5) for 3 months were significantly associated with the Apnoea-Hypopnoea Index (AHI), Oxygen Desaturation Index (ODI), Arousal Index (ArI) and intracellular-to-extracellular water ratio (I-E water ratio). Significant associations were observed between the risk of low-ArTH OSA and 1- month exposure to PM10 (OR 1.42, 95% CI 1.09 to 1.84), PM2.5 (OR 1.33, 95% CI 1.02 to 1.74) and ozone (OR 1.27, 95% CI 1.01 to 1.6). I-E water ratio alternation caused by 1-month exposure to PM10 and 3-month exposure to PM2.5 and PM10 had partial mediation effects on AHI and ODI. CONCLUSION Air pollution can directly increase sleep disorder indices (AHI, ODI and ArI) and alter body water distribution, thus mediating the risk of low-ArTH OSA.
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Affiliation(s)
- Cheng-Yu Tsai
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Ming Liu
- Department of Biology, University of Oxford, Oxford, UK
| | - Huei-Tyng Huang
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Wen-Hua Hsu
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Chun Kuan
- Sleep Center, Taipei Medical University-Shuang Ho Hospital Ministry of Health and Welfare, New Taipei City, Taiwan
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital Ministry of Health and Welfare, New Taipei, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Arnab Majumdar
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - Kang-Yun Lee
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital Ministry of Health and Welfare, New Taipei City, Taiwan
- Division of Pulmonary Medicine,Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Po-Hao Feng
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital Ministry of Health and Welfare, New Taipei City, Taiwan
- Division of Pulmonary Medicine,Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chien-Hua Tseng
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital Ministry of Health and Welfare, New Taipei City, Taiwan
- Division of Pulmonary Medicine,Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Yuan Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Jiunn-Horng Kang
- Research Center of Artificial Intelligence in Medicine, Taipei Medical University College of Medicine, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
- Graduate Institute of Nanomedicine and Medical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Hsin-Chien Lee
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Cheng-Jung Wu
- Department of Otolaryngology, Taipei Medical University-Shuang Ho Hospital Ministry of Health and Welfare, New Taipei, Taiwan
| | - Wen-Te Liu
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital Ministry of Health and Welfare, New Taipei City, Taiwan
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Sleep Center, Taipei Medical University-Shuang Ho Hospital Ministry of Health and Welfare, New Taipei City, Taiwan
- Research Center of Artificial Intelligence in Medicine, Taipei Medical University College of Medicine, Taipei, Taiwan
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Tsai CY, Huang HT, Liu M, Cheng WH, Hsu WH, Kuan YC, Majumdar A, Lee KY, Feng PH, Tseng CH, Chen KY, Kang JH, Lee HC, Wu CJ, Liu WT. Associations between air pollution, intracellular-to-extracellular water distribution, and obstructive sleep apnea manifestations. Front Public Health 2023; 11:1175203. [PMID: 37397706 PMCID: PMC10310528 DOI: 10.3389/fpubh.2023.1175203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
Background Exposure to air pollution may be a risk factor for obstructive sleep apnea (OSA) because air pollution may alter body water distribution and aggravate OSA manifestations. Objectives This study aimed to investigate the mediating effects of air pollution on the exacerbation of OSA severity through body water distribution. Methods This retrospective study analyzed body composition and polysomnographic data collected from a sleep center in Northern Taiwan. Air pollution exposure was estimated using an adjusted nearest method, registered residential addresses, and data from the databases of government air quality motioning stations. Next, regression models were employed to determine the associations between estimated air pollution exposure levels (exposure for 1, 3, 6, and 12 months), OSA manifestations (sleep-disordered breathing indices and respiratory event duration), and body fluid parameters (total body water and body water distribution). The association between air pollution and OSA risk was determined. Results Significant associations between OSA manifestations and short-term (1 month) exposure to PM2.5 and PM10 were identified. Similarly, significant associations were identified among total body water and body water distribution (intracellular-to-extracellular body water distribution), short-term (1 month) exposure to PM2.5 and PM10, and medium-term (3 months) exposure to PM10. Body water distribution might be a mediator that aggravates OSA manifestations, and short-term exposure to PM2.5 and PM10 may be a risk factor for OSA. Conclusion Because exposure to PM2.5 and PM10 may be a risk factor for OSA that exacerbates OSA manifestations and exposure to particulate pollutants may affect OSA manifestations or alter body water distribution to affect OSA manifestations, mitigating exposure to particulate pollutants may improve OSA manifestations and reduce the risk of OSA. Furthermore, this study elucidated the potential mechanisms underlying the relationship between air pollution, body fluid parameters, and OSA severity.
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Affiliation(s)
- Cheng-Yu Tsai
- Department of Civil and Environmental Engineering, Imperial College London, London, United Kingdom
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Huei-Tyng Huang
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Ming Liu
- Department of Biology, University of Oxford, Oxfordshire, United Kingdom
| | - Wun-Hao Cheng
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Respiratory Therapy, Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan
| | - Wen-Hua Hsu
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Chun Kuan
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Arnab Majumdar
- Department of Civil and Environmental Engineering, Imperial College London, London, United Kingdom
| | - Kang-Yun Lee
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Po-Hao Feng
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Chien-Hua Tseng
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Kuan-Yuan Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Jiunn-Horng Kang
- Research Center of Artificial Intelligence in Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Nanomedicine and Medical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Hsin-Chien Lee
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Cheng-Jung Wu
- Department of Otolaryngology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Wen-Te Liu
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Research Center of Artificial Intelligence in Medicine, Taipei Medical University, Taipei, Taiwan
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Liu F, Zhou F, Zhang K, Wu T, Pan M, Wang X, Tong J, Chen Z, Xiang H. Effects of air pollution and residential greenness on sleep disorder: A 8-year nationwide cohort study. ENVIRONMENTAL RESEARCH 2023; 220:115177. [PMID: 36584850 DOI: 10.1016/j.envres.2022.115177] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 12/27/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Sleep disorder influencing the quality of life, however, its contributing factors have not been fully identified yet. Recently the potential effects of environmental exposures like air pollution and greenness on sleep disorder have attracted attention, but the evidence in China is limited, particularly in the middle-aged and elderly. METHODS We conducted a nationwide prospective study that included 21,878 Chinese citizens aged 45 years or above. For each participant, the 3-year averaged exposure concentrations of air pollutants (including PM10, PM2.5, PM1, NO2) and greenness (assessed by NDVI) were estimated based on residential address. We used mixed-effects logistic models to examine the associations of sustained air pollutants and greenness exposures with the occurrence of sleep disorder, and used linear mixed-effects models to assess the associations with sleep duration. Specifically, interaction effects models were employed to identify potential modificators of the above associations. RESULTS A total of 39,580 survey responses were received, with the overall occurrence rate of sleep disorder was 25.7%. A 10 μg/m3 increment in PM10 and PM2.5 were associated with increased occurrence of sleep disorder at 2% (aOR = 1.02, 95%CI:1.01, 1.04) and 7% (aOR = 1.07, 95%CI: 1.04, 1.11), and were associated with reduced sleep duration by 0.07 (95% CI: 0.08, 0.05) and 0.04 (95% CI: 0.05, 0.03) hours, respectively. Residential greenness appears to the potential protective factor for sleep disorder, that a 0.1 higher of the NDVI was associated a 9% (aOR = 0.91, 95%CI: 0.86, 0.96) decreased occurrence of sleep disorder and 0.09 h (95% CI: 0.05, 0.13) longer of sleep duration. Age and residence were identified as modificators of the above significant associations. CONCLUSION Sustained exposure to air pollutants can increase the occurrence of sleep disorder and can reduce sleep duration, while exposure to higher levels of greenness can protect sleep health from the side effects of air pollutants.
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Affiliation(s)
- Feifei Liu
- Department of Global Health, School of Public Health, Wuhan University, 115(#) Donghu Road, Wuhan, 430071, China; Global Health Institute, School of Public Health, Wuhan University, 115(#) Donghu Road, Wuhan, 430071, China
| | - Feng Zhou
- Department of Global Health, School of Public Health, Wuhan University, 115(#) Donghu Road, Wuhan, 430071, China; Global Health Institute, School of Public Health, Wuhan University, 115(#) Donghu Road, Wuhan, 430071, China
| | - Ke Zhang
- Department of Global Health, School of Public Health, Wuhan University, 115(#) Donghu Road, Wuhan, 430071, China; Global Health Institute, School of Public Health, Wuhan University, 115(#) Donghu Road, Wuhan, 430071, China
| | - Tingting Wu
- Department of Global Health, School of Public Health, Wuhan University, 115(#) Donghu Road, Wuhan, 430071, China; Global Health Institute, School of Public Health, Wuhan University, 115(#) Donghu Road, Wuhan, 430071, China
| | - Mengnan Pan
- Department of Global Health, School of Public Health, Wuhan University, 115(#) Donghu Road, Wuhan, 430071, China; Global Health Institute, School of Public Health, Wuhan University, 115(#) Donghu Road, Wuhan, 430071, China
| | - Xiangxiang Wang
- Department of Global Health, School of Public Health, Wuhan University, 115(#) Donghu Road, Wuhan, 430071, China; Global Health Institute, School of Public Health, Wuhan University, 115(#) Donghu Road, Wuhan, 430071, China
| | - Jiahui Tong
- Department of Global Health, School of Public Health, Wuhan University, 115(#) Donghu Road, Wuhan, 430071, China; Global Health Institute, School of Public Health, Wuhan University, 115(#) Donghu Road, Wuhan, 430071, China
| | - Zhongyang Chen
- Department of Global Health, School of Public Health, Wuhan University, 115(#) Donghu Road, Wuhan, 430071, China; Global Health Institute, School of Public Health, Wuhan University, 115(#) Donghu Road, Wuhan, 430071, China
| | - Hao Xiang
- Department of Global Health, School of Public Health, Wuhan University, 115(#) Donghu Road, Wuhan, 430071, China; Global Health Institute, School of Public Health, Wuhan University, 115(#) Donghu Road, Wuhan, 430071, China.
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Bai KJ, Liu WT, Lin YC, He Y, Lee YL, Wu D, Chang TY, Chang LT, Lai CY, Tsai CY, Chung KF, Ho KF, Chuang KJ, Chuang HC. Ambient relative humidity-dependent obstructive sleep apnea severity in cold season: A case-control study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 861:160586. [PMID: 36455744 DOI: 10.1016/j.scitotenv.2022.160586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/04/2022] [Accepted: 11/26/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The objective of this study was to examine associations of daily averages and daily variations in ambient relative humidity (RH), temperature, and PM2.5 on the obstructive sleep apnea (OSA) severity. METHODS A case-control study was conducted to retrospectively recruit 8628 subjects in a sleep center between January 2015 and December 2021, including 1307 control (apnea-hypopnea index (AHI) < 5 events/h), 3661 mild-to-moderate OSA (AHI of 5-30 events/h), and 3597 severe OSA subjects (AHI > 30 events/h). A logistic regression was used to examine the odds ratio (OR) of outcome variables (daily mean or difference in RH, temperature, and PM2.5 for 1, 7, and 30 days) with OSA severity (by the groups). Two-factor logistic regression models were conducted to examine the OR of RH with the daily mean or difference in temperature or PM2.5 with OSA severity. An exposure-response relationship analysis was conducted to examine the outcome variables with OSA severity in all, cold and warm seasons. RESULTS We observed associations of mean PM2.5 and RH with respective increases of 0.04-0.08 and 0.01-0.03 events/h for the AHI in OSA patients. An increase in the daily difference of 1 % RH increased the AHI by 0.02-0.03 events/h in OSA patients. A daily PM2.5 decrease of 1 μg/m3 reduced the AHI by 0.03 events/h, whereas a daily decrease in the RH of 1 % reduced the AHI by 0.03-0.04 events/h. The two-factor model confirmed the most robust associations of ambient RH with AHI in OSA patients. The exposure-response relationship in temperature and RH showed obviously seasonal patterns with OSA severity. CONCLUSION Short-term ambient variations in RH and PM2.5 were associated with changes in the AHI in OSA patients, especially RH in cold season. Reducing exposure to high ambient RH and PM2.5 levels may have protective effects on the AHI in OSA patients.
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Affiliation(s)
- Kuan-Jen Bai
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Wen-Te Liu
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan; Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yuan-Chien Lin
- Department of Civil Engineering, National Central University, Taoyuan City, Taiwan.
| | - Yansu He
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Yueh-Lun Lee
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Dean Wu
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
| | - Ta-Yuan Chang
- Department of Occupational Safety and Health, College of Public Health, China Medical University, Taichung, Taiwan.
| | - Li-Te Chang
- Department of Environmental Engineering and Science, Feng Chia University, Taichung, Taiwan.
| | - Chun-Yeh Lai
- Department of Civil Engineering, National Central University, Taoyuan City, Taiwan
| | - Cheng-Yu Tsai
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, London, UK.
| | - Kin-Fai Ho
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; Key Laboratory of Aerosol Chemistry & Physics, Institute of Earth Environment, Chinese Academy of Sciences, Xi'an, China.
| | - Kai-Jen Chuang
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Hsiao-Chi Chuang
- 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, New Taipei City, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
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11
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Wang S, Xiong H, Wang L, Pei G, Lao M, Xu Y, Liu L, Luo S, Zhang Y, Ou Q. Association between residential greenness and obstructive sleep apnoea among adults in Southern China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 853:158414. [PMID: 36055505 DOI: 10.1016/j.scitotenv.2022.158414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/29/2022] [Accepted: 08/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND No previous study has explored the association of residential greenness with obstructive sleep apnoea (OSA) indexes. OBJECTIVE To investigate the association of exposure to residential greenness with OSA indexes in adults in Guangdong Province, Southern China. METHODS From January 1, 2005 to December 31, 2015, a total of 3925 participants were recruited from the Sleep Center of Guangdong Provincial People's Hospital. Apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) were measured by polysomnography or home sleep test (HST). Participants' daytime sleepiness scores were evaluated using The Epworth Sleeping Scale (ESS). The normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI) were used to assess residential greenness levels. Generalized linear regression models were used to assess the associations of residential greenness with OSA indexes after adjusting for multiple covariates. RESULTS The mean (standard deviation) age of the participants was 63.3 (14.4) years. In adjusted models, an interquartile range (IQR) increase in 3-year average NDVI was significantly associated with 9.8 % (95 % confidence interval [95 % CI]: 17.5 %, 2.1 %); 14.5 % (95 % CI: 24.5 %, 4.4 %) and 6.9 % (95 % CI: 13.7 %, 0.0 %) decreases in AHI, ODI and ESS scores, respectively. Furthermore, an IQR increase in 3-year average EVI was significantly associated with 7.8 % (95 % CI: 13.7 %, 1.9 %); 10.8 % (95 % CI: 18.3 %, 3.2 %) and 7.2 % (95 % CI: 12.5 %, 2.0 %) declines in AHI, ODI and ESS scores, respectively. Significant associations were only observed among males, adults aged ≥65 years old, and in the warm season. CONCLUSIONS Our study indicates that higher residential greenness was significantly associated with lower OSA indexes in adult population in South China, especially in males, in the elderly, and in the warm season.
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Affiliation(s)
- Suhan Wang
- Medical Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hailin Xiong
- Sleep Center, Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China; Departments of Medical Oncology, Huizhou Municipal Central Hospital of Guangdong Province, Huizhou, China
| | - Longlong Wang
- Sleep Center, Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Guo Pei
- Sleep Center, Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Miaochan Lao
- Sleep Center, Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Yanxia Xu
- Sleep Center, Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Linjiong Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, China
| | - Siqi Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, China
| | - Yunquan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, China
| | - Qiong Ou
- Sleep Center, Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China.
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