Supplementary Material for: Impact of Ambient Air Pollution on Obstructive Sleep Apnea Surgery: A Longitudinal Study

Introduction: Obstructive sleep apnea (OSA) is a worldwide health concern having been proved to be associated with air pollution. However, it remains unclear whether air pollution could also compromise the effect of OSA treatment, especially OSA surgery. This study investigated the impact of mid- to long-term ambient air pollution exposure on postsurgical outcomes of OSA patients.
Methods: 382 OSA patients who had failed conservative treatment first and received OSA surgery afterwards were enrolled; the patients were then categorized into the severely (192 patients; 50.3%) and mildly (190 patients; 49.7%) air-polluted group based on the calculated average exposure of air particles according to the report of Taiwan Ministry of Environment. The relationships among the airborne particles and sleep indices changes were analyzed for determining the impact of air pollution on OSA surgery.
Results: After a mid- to long-term exposure following OSA surgery, the results of the follow-up polysomnography showed that ΔAHI, ΔLSAT, and Δarousal index were significantly different between the two air-polluted groups. Pearson’s correlations revealed that the above sleep indices were significantly yet weakly associated with air quality index (AQI), SO2, NO2, CO, and O3. After adjusting the confounding factors, the multivariate analysis showed that different air pollution levels still had statistically significant influence on Δarousal index (β=-0.105, p=.045).
Conclusion: Despite the effectiveness of OSA surgery, mid- to long-term exposure to ambient air pollution postoperatively may still have statistically significant association on OSA patients’ postsurgical outcomes, and thus could not be overlooked.

引言：阻塞性睡眠呼吸暂停（Obstructive sleep apnea, OSA）是一项全球性公共健康问题，现有研究已证实其与空气污染存在关联。但目前仍不明确的是，空气污染是否也会削弱OSA治疗的效果，尤其是OSA手术治疗。本研究旨在探究中长期室外空气污染暴露对OSA患者术后预后的影响。
方法：本研究纳入382例经保守治疗失败后接受OSA手术的患者；随后依据台湾环境部门公布的空气颗粒物平均暴露水平，将患者划分为重度污染组（192例，占比50.3%）与轻度污染组（190例，占比49.7%）。通过分析大气颗粒物与睡眠指标变化之间的关联，以明确空气污染对OSA手术预后的影响。
结果：OSA术后中长期暴露后，随访多导睡眠图（polysomnography）结果显示，ΔAHI（呼吸暂停低通气指数变化值）、ΔLSAT（最低血氧饱和度变化值）以及Δarousal index（觉醒指数变化值）在两组污染人群中存在显著差异。皮尔逊相关分析显示，上述睡眠指标与空气质量指数（Air Quality Index, AQI）、二氧化硫（SO2）、二氧化氮（NO2）、一氧化碳（CO）及臭氧（O3）均呈显著但较弱的相关性。在校正混杂因素后，多因素分析结果显示，不同空气污染水平仍对觉醒指数变化值具有统计学意义的显著影响（β=-0.105，P=0.045）。
结论：尽管OSA手术具有明确的治疗效果，但术后中长期暴露于室外空气污染仍与OSA患者的术后预后存在统计学意义上的显著关联，因此不容忽视。