Variations and Clinical Significance of Sleep Monitoring Indicators among Healthy Adults of Different Ages and Genders in Various Altitudes

doi:10.12114/j.issn.1007-9572.2023.0538

Abstract

Abstract:

Background

Sleep disturbances are the most common health issues in high-altitude environments. Current research on the sleep architecture of healthy populations is limited to the same altitude and involves a small number of subjects, lacking sufficient reliability.

Objective

This study aims to analyze the differences in sleep monitoring indicators among healthy adults of different ages and genders across various altitudes, exploring the impact of altitude, age, and gender interactions on these indicators.

Methods

Healthy volunteers recruited from the plains of Chengdu, Sichuan Province, and the plateau area of Kunming, Yunnan Province, from January 2020 to September 2022 were selected as study subjects. Volunteers' gender, height, body mass, Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS) were collected. Total sleep time (TST), sleep efficiency, and sleep parameters [percentage of stage N1 (N1%), stage N2 (N2%), stage N3 (N3%) of non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep in total sleep time] were recorded. Age was categorized into two groups (20-39 and 40-60 years) for a two-way ANOVA to explore the effects of age, gender, and altitude on sleep parameters.

Result

A total of 91 people were recruited in low-altitude areas, including 48 men and 43 women. A total of 90 people were recruited for the high-altitude area, including 46 men and 44 women. In females, TST was higher in high-altitude areas compared to low-altitude areas (P<0.05). In both males and females, N1% was higher and N2% was lower in high-altitude areas (P<0.05). N3% was higher in females than in males in high-altitude areas (P<0.05). In males, REM% was higher in high-altitude areas (P<0.05). TST was higher in the 20-39 age group than in the 40-60 age group in high-altitude areas (P<0.05). Sleep efficiency was higher in the 40-60 age group in low-altitude areas compared to high-altitude areas, with the 20-39 age group showing higher sleep efficiency in high-altitude areas (P<0.05). In both age groups, N1% was higher in high-altitude areas (P<0.05). In low-altitude areas, N1% was higher in the 20-39 age group than in the 40-60 age group, whereas in high-altitude areas, it was lower in the 20-39 age group (P<0.05). N2% was higher in low-altitude areas in both age groups (P<0.05), with the 40-60 age group having a higher N2% in high-altitude areas (P<0.05). N3% was higher in the 20-39 age group in high-altitude areas (P<0.05). In low-altitude areas, N3% was lower in the 20-39 age group compared to the 40-60 age group, while in high-altitude areas, it was higher in the 20-39 age group (P<0.05). REM% was higher in high-altitude areas in both age groups (P<0.05) .

Conclusion

The factors of age and altitude have varying degrees of influence on total sleep time, sleep efficiency, N1%, N2%, and REM%. Age factors have a greater impact on sleep structure, the older the age, the shorter TST, the lower the sleep efficiency, the higher the proportion of N1. The higher the altitude, the greater the influence of age on sleep structure. In the high altitude area, the TST, sleep efficiency and N3% of the elderly population are lower, and the proportion of N1% is higher.

Key words: Dyssomnias, Altitude, Sleep monitoring, Adult

摘要： 背景睡眠问题是高海拔环境最常见的健康问题。目前对健康人群睡眠结构的研究仅限于同一海拔高度，且研究受试者数量较少，研究的可靠性尚未得到充分认证。目的对不同海拔地区，不同年龄、不同性别健康成人睡眠监测指标差异性进行研究分析，探讨海拔高度和年龄、性别的交互作用对睡眠监测指标的影响。方法选取2020年1月—2022年9月四川省成都市平原地区和云南省昆明市高原地区招募的健康志愿者作为研究对象。收集志愿者的性别、身高、体质量、匹兹堡睡眠质量指数（PSQI）、Epworth睡眠质量指数（ESS）。记录总睡眠时间（TST）、睡眠效率、睡眠参数[非快速眼动睡眠1期占总睡眠时间的百分比（N1%）、非快速眼动睡眠2期占总睡眠时间的百分比（N2%）、非快速眼动睡眠3期占总睡眠时间的百分比（N3%）、快速眼动睡眠期占总睡眠时间的百分比（REM%）]。将年龄作为二分类变量（20~39岁及40~60岁），采用双因素方差分析探究年龄、性别与海拔对各睡眠参数的影响。结果低海拔地区共招募91人，其中男48人、女43人；高海拔地区共招募90人，其中男46人、女44人。女性群体中，高海拔地区TST高于低海拔地区（P<0.05）；男性群体与女性群体中，高海拔地区N1%高于低海拔地区，N2%低于低海拔地区（P<0.05）；高海拔地区女性N3%高于男性（P<0.05）；男性群体中，高海拔地区REM%高于低海拔地区（P<0.05）。高海拔地区20~39岁群体TST高于40~60岁群体（P<0.05）；40~60岁群体低海拔地区睡眠效率高于高海拔地区，高海拔地区20~39岁群体睡眠效率高于40~60岁群体（P<0.05）；20~39岁群体与40~60岁群体中，高海拔地区N1%均高于低海拔地区（P<0.05）；低海拔地区20~39岁群体N1%高于40~60岁群体，高海拔地区20~39岁群体N1%低于40~60岁群体（P<0.05）；20~39岁群体与40~60岁群体中，低海拔地区N2%均高于高海拔地区（P<0.05）；高海拔地区40~60岁人群N2%高于20~39岁人群（P<0.05）；20~39岁群体中，高海拔地区N3%高于低海拔地区（P<0.05）；低海拔地区20~39岁群体N3%低于40~60岁群体，高海拔地区20~39岁群体N3%高于40~60岁群体（P<0.05）；20~39岁群体与40~60岁群体中，高海拔地区REM%均高于低海拔地区（P<0.05）。结论年龄和海拔因素对总睡眠时间、睡眠效率、N1%、N2%、REM%均有不同程度的影响。年龄因素对睡眠结构的影响更大，年龄越大，TST越短，睡眠效率越低，N1占比越高。海拔越高，年龄对睡眠结构的影响更大，在高海拔地区中，高龄人群的TST、睡眠效率、N3%较低，N1%比例更高。

关键词: 睡眠异常, 高海拔, 睡眠监测, 成年人

YANG Linglin,CHEN Yujie,WANG Yi, et al. Variations and Clinical Significance of Sleep Monitoring Indicators among Healthy Adults of Different Ages and Genders in Various Altitudes[J]. Chinese General Practice, 2024, 27(24): 2961-2968. DOI: 10.12114/j.issn.1007-9572.2023.0538.
杨凌麟,陈宇洁,王怡等. 不同海拔地区不同年龄、性别健康成人睡眠监测指标差异性及临床意义研究[J]. 中国全科医学, 2024, 27(24): 2961-2968. DOI: 10.12114/j.issn.1007-9572.2023.0538.

Figures/Tables 13

References 22

[1]	HOSHIKAWA M，UCHIDA S，SUGO T，et al. Changes in sleep quality of athletes under normobaric hypoxia equivalent to 2 000-m altitude：a polysomnographic study[J]. J Appl Physiol，2007，103（6）：2005-2011. DOI：10.1152/japplphysiol.00315.2007.
[2]	MIZUNO K，ASANO K，OKUDAIRA N. Sleep and respiration under acute hypobaric hypoxia[J]. Jpn J Physiol，1993，43（2）：161-175. DOI：10.2170/jjphysiol.43.161.
[3]	VENTER R E. Role of sleep in performance and recovery of athletes：a review article[J]. S Afr N J Res Sport Phys Educ Recreat，2012，34（1）：167-184.
[4]	DANKER-HOPFE H，SCHÄFER M，DORN H，et al. Percentile reference charts for selected sleep parameters for 20- to 80-Year-Old healthy subjects from the SIESTA database[J]. Somnologie，2005，9（1）：3-14. DOI：10.1111/j.1439-054X.2004.00038.x.
[5]	BEAUMONT M，BATÉJAT D，COSTE O，et al. Effects of zolpidem and zaleplon on sleep，respiratory patterns and performance at a simulated altitude of 4，000 M[J]. Neuropsychobiology，2004，49（3）：154-162. DOI：10.1159/000076723.
[6]	PANJWANI U，THAKUR L，ANAND J P，et al. Sleep architecture at 3500 meters in a sample of Indians[J]. Sleep Biol Rhythms，2007，5（3）：159-165. DOI：10.1111/j.1479-8425.2007.00273.x.
[7]	ZIELIŃSKI J，KOZIEJ M，MAŃKOWSKI M，et al. The quality of sleep and periodic breathing in healthy subjects at an altitude of 3，200 M[J]. High Alt Med Biol，2000，1（4）：331-336. DOI：10.1089/15270290050502408.
[8]	JAFARIAN S，GOROUHI F，TAGHVA A，et al. High-altitude sleep disturbance：results of the Groningen Sleep Quality Questionnaire survey[J]. Sleep Med，2008，9（4）：446-449. DOI：10.1016/j.sleep.2007.06.017.
[9]	ANDERSON P J，WISTE H J，OSTBY S A，et al. Sleep disordered breathing and acute mountain sickness in workers rapidly transported to the South Pole（2 835 m）[J]. Respir Physiol Neurobiol，2015，210：38-43. DOI：10.1016/j.resp.2015.01.012.
[10]	LATSHANG T D，LO CASCIO C M，STÖWHAS A C，et al. Are nocturnal breathing，sleep，and cognitive performance impaired at moderate altitude（1 630-2 590 m）?[J]. Sleep，2013，36（12）：1969-1976. DOI：10.5665/sleep.3242.
[11]	NUSSBAUMER-OCHSNER Y，URSPRUNG J，SIEBENMANN C，et al. Effect of short-term acclimatization to high altitude on sleep and nocturnal breathing[J]. Sleep，2012，35（3）：419-423. DOI：10.5665/sleep.1708.
[12]	NUSSBAUMER-OCHSNER Y，SCHUEPFER N，ULRICH S，et al. Exacerbation of sleep apnoea by frequent central events in patients with the obstructive sleep apnoea syndrome at altitude：a randomised trial[J]. Thorax，2010，65（5）：429-435. DOI：10.1136/thx.2009.125849.
[13]	PUN M，HARTMANN S E，FURIAN M，et al. Effect of acute，subacute，and repeated exposure to high altitude（5050 m）on psychomotor vigilance[J]. Front Physiol，2018，9：677. DOI：10.3389/fphys.2018.00677.
[14]	HEINZER R，SAUGY J J，RUPP T，et al. Comparison of sleep disorders between real and simulated 3，450-m altitude[J]. Sleep，2016，39（8）：1517-1523. DOI：10.5665/sleep.6010.
[15]	美国睡眠医学会. 睡眠及其相关事件判读手册：规则、术语和技术规范2.6版[M]. 孙毅，孙煜，崔丽，译. 杭州：浙江大学出版社，2021：1-151.
[16]	哈振德，朱金银，简新玲. 不同干预措施对移居海拔5380m青年睡眠SaO₂的影响[J]. 高原医学杂志，2015，25（4）：12-16.
[17]	吴天一. 高原病的诊断、预防和治疗指南[M]. 兰州：兰州大学出版社，2014.
[18]	DAS S K，DHAR P，SHARMA V K，et al. High altitude with monotonous environment has significant impact on mood and cognitive performance of acclimatized lowlanders：possible role of altered serum BDNF and plasma homocysteine level[J]. J Affect Disord，2018，237：94-103. DOI：10.1016/j.jad.2018.04.106.
[19]	TAN L，LI T M，LEI F，et al. Longer apnea duration at low altitude in Tibetan and Han highlanders compared with Han lowlanders：a retrospective study[J]. J Sleep Res，2020，29（2）：e12934. DOI：10.1111/jsr.12934.
[20]	WHITELAW W. Mechanisms of sleep apnea at altitude[J]. Adv Exp Med Biol，2006，588：57-63. DOI：10.1007/978-0-387-34817-9_6.
[21]	吴旸，包大鹏，许春艳. 低氧环境对成年人睡眠影响的meta分析[J]. 环境与健康杂志，2019，36（2）：124-129. DOI：10.16241/j.cnki.1001-5914.2019.02.008.
[22]	DE AQUINO LEMOS V，ANTUNES H K，DOS SANTOS R V，et al. High altitude exposure impairs sleep patterns，mood，and cognitive functions[J]. Psychophysiology，2012，49（9）：1298-1306. DOI：10.1111/j.1469-8986.2012.01411.x.

项目	低海拔地区（n=91）	高海拔地区（n=90）	检验统计量值	P值
性别（男/女）	48/43	46/44	14.791^a	0.064
年龄（岁）	43.0±13.7	42.2±12.6	4.486^b	0.059
身高（cm）	164.4±8.1	163.5±7.4	2.834^b	0.061
体质量（kg）	61.3±10.3	60.5±9.3	3.624^b	0.053
PSQI评分[M（P₂₅，P₇₅），分]	4.00（3.00，5.00）	3.00（2.00，5.00）	-1.897	0.058
ESS评分[M（P₂₅，P₇₅），分]	3.00（2.00，4.00）	3.00（2.00，5.00）	-2.199	0.068
AHI[M（P₂₅，P₇₅），次/h]	4.45（3.10，5.70）	4.90（3.40，5.40）	-1.962	0.059

项目	低海拔地区（n=91）	高海拔地区（n=90）	检验统计量值	P值
性别（男/女）	48/43	46/44	14.791^a	0.064
年龄（岁）	43.0±13.7	42.2±12.6	4.486^b	0.059
身高（cm）	164.4±8.1	163.5±7.4	2.834^b	0.061
体质量（kg）	61.3±10.3	60.5±9.3	3.624^b	0.053
PSQI评分[M（P₂₅，P₇₅），分]	4.00（3.00，5.00）	3.00（2.00，5.00）	-1.897	0.058
ESS评分[M（P₂₅，P₇₅），分]	3.00（2.00，4.00）	3.00（2.00，5.00）	-2.199	0.068
AHI[M（P₂₅，P₇₅），次/h]	4.45（3.10，5.70）	4.90（3.40，5.40）	-1.962	0.059

因子	自由度	平方和	平均平方误差	F值	P值
海拔	1	5 607.595	5 607.595	1.689	0.195
性别	1	19.348	19.348	0.006	0.939
海拔×性别	2	8 721.187	8 721.187	2.627	0.106
误差	227	753 474.842	3 319.272
总计	231	37 597 425.370

因子	自由度	平方和	平均平方误差	F值	P值
海拔	1	5 607.595	5 607.595	1.689	0.195
性别	1	19.348	19.348	0.006	0.939
海拔×性别	2	8 721.187	8 721.187	2.627	0.106
误差	227	753 474.842	3 319.272
总计	231	37 597 425.370

因子	自由度	平方和	平均平方误差	F值	P值
海拔	1	355.396	355.396	4.072	0.065
性别	1	164.180	164.180	1.881	0.172
海拔×性别	1	17.102	17.102	0.196	0.658
误差	227	19 811.621	87.276
总计	231	1 645 570.790