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已发表论文
阻塞性睡眠呼吸暂停综合征患者骨代谢及炎症标志物与主要不良心血管事件的相关性研究
Authors Guo G, Xiao J, Chen J, Zhu C, Zhang Q, Li F
Received 26 May 2025
Accepted for publication 27 October 2025
Published 11 November 2025 Volume 2025:18 Pages 15817—15831
DOI https://doi.org/10.2147/JIR.S538725
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Qing Lin
Guohua Guo,1,2 Jianhong Xiao,1,2 Junhua Chen,1,2 Chuanqi Zhu,1,2 Qinghua Zhang,1,2 Feng Li1,2
1Department of Respiratory and Critical Care Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fu’an, Fujian Province, 355000, People’s Republic of China; 2Department of Infectious Diseases, Mindong Hospital Affiliated to Fujian Medical University, Fu’an, Fujian Province, 355000, People’s Republic of China
Correspondence: Feng Li, Department of Respiratory and Critical Care Medicine, Mindong Hospital Affiliated to Fujian Medical University, No. 89 Heshan Road, Chengnan Street, Fu’an, Fujian Province, 355000, People’s Republic of China, Email txzzyx2023@163.com
Background: Obstructive sleep apnea syndrome (OSAS) elevates the risk of major adverse cardiovascular events (MACEs), though the underlying mechanisms are not fully elucidated. This study investigated the correlations between bone metabolism markers, inflammatory cytokines, and MACEs in OSAS patients.
Methods: A retrospective study was conducted on patients diagnosed with OSAS between March 2019 and March 2022, alongside baseline characteristics - matched controls without OSAS. The cohort comprised 496 OSAS patients and 545 controls. Based on the occurrence of major adverse cardiovascular events (MACEs), the entire cohort (n=1041) was segregated into a MACE group (n=120) and a non-MACE group (n=921). Clinical data collected included demographic information, polysomnography results, bone metabolism markers (β-CrossLaps [β-CTX], total procollagen type I N-terminal propeptide [TPINP]), and inflammatory cytokines (interleukin-1 beta [IL-1β], interleukin-6 [IL-6], C-reactive protein [CRP], tumor necrosis factor-alpha [TNF-α], interleukin-10 [IL-10], interferon-gamma [IFN-γ]). Statistical analyses included independent t tests, Pearson correlation coefficients, logistic regression, and structural equation modeling.
Results: OSAS patients showed significantly higher β-CTX (0.49± 0.15 vs 0.43± 0.14 ng/mL; P< 0.001) and lower TPINP (103.81± 37.57 vs 118.19± 41.20 ng/mL; P< 0.001) than controls. Levels of IL-6, TNF-α, and IL-1β were also elevated in the OSAS group (all P< 0.01). MACEs were more frequent in OSAS patients (P=0.002). Multivariate analysis identified severe OSAS (OR=2.771, P< 0.001), elevated IL-6 (OR=1.114, P=0.013), elevated IL-1β (OR=1.598, P=0.033), and increased β-CTX (OR=3.386, P< 0.001) as independent MACE predictors. SEM revealed OSAS directly associated with MACEs (β=0.18) and indirectly via inflammatory and bone metabolism pathways.
Conclusion: Altered bone metabolism markers and elevated pro-inflammatory cytokines are associated with an increased risk of MACEs in OSAS patients, suggesting their role in the pathophysiology of OSAS-related cardiovascular morbidity. Monitoring these markers could aid in risk stratification.
Keywords: obstructive sleep apnea syndrome, bone metabolism, inflammatory markers, major adverse cardiovascular events
1Department of Respiratory and Critical Care Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fu’an, Fujian Province, 355000, People’s Republic of China; 2Department of Infectious Diseases, Mindong Hospital Affiliated to Fujian Medical University, Fu’an, Fujian Province, 355000, People’s Republic of China
Correspondence: Feng Li, Department of Respiratory and Critical Care Medicine, Mindong Hospital Affiliated to Fujian Medical University, No. 89 Heshan Road, Chengnan Street, Fu’an, Fujian Province, 355000, People’s Republic of China, Email txzzyx2023@163.com
Background: Obstructive sleep apnea syndrome (OSAS) elevates the risk of major adverse cardiovascular events (MACEs), though the underlying mechanisms are not fully elucidated. This study investigated the correlations between bone metabolism markers, inflammatory cytokines, and MACEs in OSAS patients.
Methods: A retrospective study was conducted on patients diagnosed with OSAS between March 2019 and March 2022, alongside baseline characteristics - matched controls without OSAS. The cohort comprised 496 OSAS patients and 545 controls. Based on the occurrence of major adverse cardiovascular events (MACEs), the entire cohort (n=1041) was segregated into a MACE group (n=120) and a non-MACE group (n=921). Clinical data collected included demographic information, polysomnography results, bone metabolism markers (β-CrossLaps [β-CTX], total procollagen type I N-terminal propeptide [TPINP]), and inflammatory cytokines (interleukin-1 beta [IL-1β], interleukin-6 [IL-6], C-reactive protein [CRP], tumor necrosis factor-alpha [TNF-α], interleukin-10 [IL-10], interferon-gamma [IFN-γ]). Statistical analyses included independent t tests, Pearson correlation coefficients, logistic regression, and structural equation modeling.
Results: OSAS patients showed significantly higher β-CTX (0.49± 0.15 vs 0.43± 0.14 ng/mL; P< 0.001) and lower TPINP (103.81± 37.57 vs 118.19± 41.20 ng/mL; P< 0.001) than controls. Levels of IL-6, TNF-α, and IL-1β were also elevated in the OSAS group (all P< 0.01). MACEs were more frequent in OSAS patients (P=0.002). Multivariate analysis identified severe OSAS (OR=2.771, P< 0.001), elevated IL-6 (OR=1.114, P=0.013), elevated IL-1β (OR=1.598, P=0.033), and increased β-CTX (OR=3.386, P< 0.001) as independent MACE predictors. SEM revealed OSAS directly associated with MACEs (β=0.18) and indirectly via inflammatory and bone metabolism pathways.
Conclusion: Altered bone metabolism markers and elevated pro-inflammatory cytokines are associated with an increased risk of MACEs in OSAS patients, suggesting their role in the pathophysiology of OSAS-related cardiovascular morbidity. Monitoring these markers could aid in risk stratification.
Keywords: obstructive sleep apnea syndrome, bone metabolism, inflammatory markers, major adverse cardiovascular events