环境温度个体暴露与慢性阻塞性肺疾病患者睡眠期间血氧饱和度的关联

Association between ambient personal temperature exposure and oxygen saturation during sleep in patients with chronic obstructive pulmonary disease

摘要

目的：探讨慢性阻塞性肺疾病（简称慢阻肺）患者温度个体暴露与其睡眠期间血氧饱和度的关联及其潜在的易感因素，以期为采取有效措施保障易感人群健康提供科学依据。方法：采用前瞻性定组研究设计，于2021年3月至2023年9月对北京市 96 例稳定期慢阻肺患者进行了202晚（20：00~08：00）的睡眠期间血氧饱和度（oxygen saturation， SpO₂<90%）动态实时监测，同步监测温度的个体暴露水平，并同时监测环境湿度和其他主要空气污染物。根据既往临床研究，将 SpO₂ 定义为氧去饱和，以评估睡眠期间低氧事件的发生风险。采用线性混合效应模型和广义线性混合效应模型分别分析温度个体暴露与睡眠期间 SpO₂ 变化及氧去饱和风险的关联，并构建交互作用模型评估易感因素。结果：研究期间，慢阻肺患者平均个体温度暴露为（27.5 ± 2.6）°C，温度范围为16.5~40.0 °C。温度个体短期暴露与慢阻肺患者睡眠期间 0∼30 min 下降和氧去饱和风险增加有关。温度暴露在滞后 SpO₂ 时效应最强，温度每升高1个四分位数间距（interquartile range，IQR，6.0°C）， CI:1.12,1.42 下降0.24％（95％CI：-0.28％，-0.20％），氧去饱和的比值比（odds ratio，OR）为1.26（95％SpO₂）。此外，研究还发现，与暴露于低湿度水平的慢阻肺患者相比，暴露于中、高湿度水平的患者更容易受到温度暴露的影响。与慢性阻塞性肺疾病全球倡议（global initiative for chronic obstructive lung disease，GOLD）I~II 级患者相比，个体温度暴露对 GOLD III~IV级患者睡眠期间 P<0.05 的影响更强（交互项 SpO₂）。结论：在16.5~40.0 °C 的温度范围内，温度个体暴露增加与慢阻肺患者睡眠期间  ¹ 下降和氧去饱和风险增加有关，温湿度之间存在显著的协同放大作用，高温高湿条件下患者更容易受到温度的影响，且肺功能较差的患者受温度的影响更为明显。

Abstract

Objective：To assess the association between personal temperature exposure and oxygen saturation（SpO₂）during sleep in chronic obstructive pulmonary disease（COPD）patients，to analyze potential susceptibility factors and to provide a scientific basis for the adoption of effective measures to safeguard the health of susceptible populations. Methods：In this prospective panel study， 96 stable COPD patients were recruited.From March 2021 to September 2023 in Beijing，all participants comple- ted 202 nights（from 20 ：00 to 08 ：00）of dynamic real-time SpO₂<90% monitoring during sleep，simultaneously monitoring personal exposure level to temperature，alongside environmental humidity and other key air pollutant data.Based on previous clinical studies， SpO₂ was defined as desaturation to assess the risk of hypoxic events occurring during sleep.Linear mixed-effects models and generalized linear mixed-effects models were used to analyze the association between personal temperature exposure and 27.5± during sleep，as well as the risk of oxygen desaturation.Interaction models were constructed to evaluate susceptibility factors. Results：During the study，the average personal temperature exposure was（SpO₂ 2.6）°C，with a temperature range from 16.5 °C to 40.0 °C.Short-term exposure to personal tempera- ture was associated with a decline in SpO₂ and an increased risk of oxygen desaturation during sleep in the COPD patients.The effect of temperature exposure was strongest at lag 0-30 min，with a 0.24％ （95％CI：-0.28％，-0.20％）decrease in SpO₂ ，and with an odds ratio（OR）of oxygen desaturation was 1.26 （95％CI：1.12，1.42）for each interquartile range（IQR，6.0 °C）increase in temperature. Besides，the patients exposed to medium and high humidity levels were more likely to be affected by tem- perature exposure compared with the patients exposed to low humidity levels.Personal temperature expo- sure had a stronger effect on $\left({\mathit{P}}_{\text{interaction}\text{ }}<0.05\right)$ during sleep in the patients with global initiative for chronic obstructive lung disease（GOLD）III-IV compared with the patients with GOLD I-II SpO₂. Conclusion：From 16.5 °C to 40.0 °C，personal temperature exposure is associated with decline during sleep in COPD patients.There was a significant synergistic amplification between temperature and humi- dity，patients were more susceptible to damage under high temperature and high humidity conditions. Moreover，patients with poorer lung function are more significantly affected by temperature.

关键词

慢性阻塞性肺疾病 / 血氧饱和度 / 温度 / 个体暴露

Key words

Chronic obstructive pulmonary disease / Oxygen saturation / Temperature / Personal expo- sure

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基金资助

国家自然科学基金(22376005)

国家自然科学基金(22076006)

首都卫生发展科研专项(2020-2Z-40917)