2026-11-092026-11-09https://scholars.csmu.edu.tw/handle/123456789/38631Overwhelming researches suggests obese patients are at higher risk from major medical disease and weight loss improves longevity or all-cause mortality. It appears quite relevant and timely that the International Diabetes Federation (IDF) suggests central obesity is a prerequisite risk factor metabolic syndrome. People with the metabolic syndrome are at increased risk for developing morbidity and mortality of major medical problems including cardiovascular diseases. The high prevalent sleep disordered breathing (SDB) is comorbided with hypertension or coronary artery disease, which is hard to be fully explained by known confounding factors. Furthermore cause-effect link between SDB and cardiovascular morbidity and mortality is almost established. On the other hand, central obesity (visceral fat), associated with hyperinsulinemia, insulin resistance, dyslipidemia and systemic inflammation, is likely the major determinant of SDB. Thus, it is postulate to confer SDB as a crucial role associated with metabolic syndrome and with systemic inflammatory situation. Intriguingly, well-randomized and large-sized studies, either cross-sectional or longitudinal, are lack in examining the overall association of SDB with metabolic syndrome. Further, a few researches demonstrated that some biomarkers for inflammation might had relationship with severity of SDB based on RDI, although possible bias on selection and relatively on small size. We hypothesized that SDB would be associated, in dose manner, with metabolic syndrome’ parameters and inflammatory biomarkers, independent of obesity. To reach this aim, we will recruit continuously around 700 patients with sleep disordered breathing, when attending to the Sleep Clinics, Chung Shan Medical University Hospital, from upcoming two years, with a chief complaint of sleep disturbance. The blood pressure, fasting glucose, fasting lipid profile and inflammatory markers (IL-2, IL-4, IL-5, IL-6, IL-10, IL-12, IL-18, IFN-γ, TNF-α, CRP, SAA, ST2, fibrinogen, BNP, and soluble adhesion molecules sVCAM-1, sICAM-1, and sE-selectin) will be measured in the morning just after an overnight sleep polysomnographic study in our Sleep Center. To determine whether dosage or threshold effect exists between SDB and individual variable of metabolic syndrome (defined by IDF) and syndrome itself and severity of systemic inflammation, the degree of SDB will be categorized by apnea-hypopnea index into 5 subgroups (i.e., R0, 0 to 4.9; R1, 5.0 to 14.9; R2, 15.0 to 29.9; R3, 30.0 to 69.9 and R4, 70.0 or more events/hour, respectively). Among these groups, we will use Kruskal-Wallis test and Mann-Whitney U tests to determine the differences among all subgroups and between each two subgroups in absolute value of all metabolic syndrome- components and x 2 tests positive percentage in each component among all subgroups. We will further use logistic-regression analysis to estimate the odds ratios for the presence of individual metabolic syndrome-component and this syndrome and various inflammatory biomarkers in R1, R2, R3 and R4 subgroups with R0 subgroup, as the reference group. We will examine the following variables as covariates: age, sex, smoking, alcohol consumption, regular exercise and body mass index.代謝症候群病患在發生心血管疾病等重大疾病之發生率與死亡率明顯增高。有更 多的證據支持肥胖病患亦存在上述現象，可因體重降低而下降罹患病率及死亡率。 而國際糖尿病聯合會（IDF）適時將中心型肥胖定義為代謝症候群必要條件自有其意 義。而睡眠呼吸障礙，這種高發生率的徵候常與高血壓及冠狀動脈疾病共存。此現 象絕非已知的干擾因子所能完全闡明。更者，睡眠呼吸障礙與心血管疾病罹病與死 亡率的因果關係近乎確立。而另一方面中心型肥胖這種會造成胰島素升高，胰島素 敏感度下降、血脂異常與全身發炎，又被稱為睡眠呼吸障礙的加重因子。整體而言 似乎已說明睡眠呼吸障礙應與代謝症候群、及各類發炎生化指標相關。令人疑惑的 是，至今無論橫斷或是縱形的研究，鮮少有均佈且大型的研究探討睡眠呼吸障礙與 代謝症候群及發炎狀態相關性。又，國內的睡眠呼吸障礙病患不若歐美肥胖是否亦 導致嚴重的全身發炎仍是未知。因此我們假設：在肥胖因子干擾之外，睡眠呼吸障 礙與代謝症候群的及全身發炎狀態相關性不僅存在且具劑量效應。為達此一目標， 在未來二年內我們擬在中山醫學大學附設醫院睡眠中心，因睡眠不佳從門診來的病 患收集進700 人。除ㄧ般的基本資料外在睡眠檢查後隔日清晨量測血壓，抽血檢驗 血糖、血脂肪與多項發炎生化指標( IL-2, IL-4, IL-5, IL-6, IL-10, IL-12, IL-18, IFN-g, TNF-a, CRP, SAA, ST2, fibrinogen, BNP, and soluble adhesion molecules sVCAM-1, sICAM-1, and sE-selectin)，並分析睡眠檢查之結果。依睡眠呼吸障礙指標 分為五小組即(R0，0-04.9；R1，5-14.9；R2，15.0-29.9；R3，30.0-69.9 及R4， 70.0 以上)並針對上述腹圍、血壓、血糖、血脂、發炎生化指標與睡眠品質資料運算 以Kruskal-Wallis test and Mann-Whitney U tests 方法統計出各組間在值與發生率的不同， 並考慮可能的干擾因子如年齡、性別、抽菸、飲酒、運動習慣、與身高體重指標。以R0 組為 參考組，利用邏輯回歸方式分析，依睡眠呼吸障礙指標高低不同的各組在個別代謝症候群因 子與代謝症候群發生率及發炎生化指標的相關性。Project