Author:
Yang Zhe,Lv Tian,Lv Xiaoheng,Wan Fangyuan,Zhou Hong,Wang Xiaoling,Zhang Lisan
Abstract
AbstractThe study investigated the association between Serum Uric Acid (SUA) levels and all-cause as well as cardiovascular mortality in patients with Obstructive Sleep Apnea (OSA). This prospective cohort study enrolled participants with OSA from four cycles of the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2008, and 2015–2018. A weighted Cox proportional hazards model was used to assess adjusted hazard ratios (aHRs) and their corresponding 95% confidence intervals (CI) for all-cause and cardiovascular mortality. Additionally, multivariable logistic regression and restricted cubic splines (RCS) models were employed to examine nonlinear relationships between SUA and all-cause and cardiovascular mortality. Among the 5,584 OSA participants included in the study, covering the four NHANES cycles and with a median follow-up of 4.333 years, a total of 537 deaths were observed, including 108 deaths attributed to cardiovascular disease. Comparing the fourth quartile (Q4) of uric acid levels, both the fifth quartile (Q5) (aHRs = 1.51, 95% CI [1.08, 2.12]) and the second quartile (Q2) (aHRs = 1.53, 95% CI [1.04, 2.25]) of uric acid levels were independently associated with an increased risk of all-cause mortality. Furthermore, comparing the fourth quartile (Q4) of uric acid levels, the second quartile (Q2) (aHRs = 2.40, 95% CI [1.08, 5.35]) of uric acid levels were independently associated with an increased risk of cardiovascular mortality. The RCS model demonstrated a U-shaped pattern in the association between SUA and all-cause mortality in OSA, with an inflection point observed at 5.83 mg/dl. The findings of this study suggest a U-shaped association between serum SUA levels and all-cause mortality and nonlinearity association between serum SUA levels and all-cause mortality. Further studies are warranted to determine the causal relationship between SUA levels and all-cause and cardiovascular mortality.
Publisher
Springer Science and Business Media LLC
Reference35 articles.
1. Brodie, K. D. & Goldberg, A. N. Obstructive sleep apnea: a surgeon’s perspective. Med. Clin. North Am. 105(5), 885–900 (2021).
2. Benjafield, A. V. et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir. Med. 7(8), 687–698 (2019).
3. Senaratna, C. V. et al. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Med. Rev. 34, 70–81 (2017).
4. Waring, W. S., Webb, D. J. & Maxwell, S. R. Systemic uric acid administration increases serum antioxidant capacity in healthy volunteers. J. Cardiovasc. Pharmacol. 38(3), 365–371 (2001).
5. You, H. et al. U-shaped relationship between cardiovascular mortality and serum uric acid may be attributed to stroke- and heart-specific mortality, respectively, among hypertensive patients: a nationally representative cohort study. Med. Sci. Monit. 27, e928937 (2021).