title: Obstructive sleep apnea rather than diabetes or obesity associated with proteinuria in late mid-aged male workers: a decision tree analysis.
abstract: BACKGROUND
  Both proteinuria and obstructive sleep apnea (OSA) are associated with cardiovascular events and consequent mortality. To examine whether age, OSA, diabetes, and obesity are potential predictors of proteinuria, a data-driven analysis was performed to delineate a potential categorical classification algorithm.
  
  
  METHODS
  In this cross-sectional community-based cohort study, demographic data, blood pressure, serum biochemical analyses, proteinuria via single dipstick urinalysis, and overnight polysomnographies were measured in 300 males with sedentary work styles.
  
  
  RESULTS
  Sixty-one (20.3 %) of all these participants had proteinuria. Logistic regression analysis showed that glycated hemoglobin (HbA1c), duration of arterial oxygen saturation <90 %, age, and log high-sensitivity C-reactive protein, but not apnea-hypopnea index (AHI), were responsible for 16.7 % of the variance of proteinuria's presence. A decision tree analysis showed that subjects over 49 years old had a higher risk for proteinuria than those subjects of 49 years old, or less. In the over 49-year-old group, subjects with an AHI >21 events/h had a higher risk for proteinuria; whereas in the 49-year-old and less group, subjects with HbA1c >7 %, or with HbA1c ≤7, and body mass index (BMI) >27.4 kg/m(2) had a higher risk for proteinuria than their counterparts.
  
  
  CONCLUSIONS
  AHI was the major determinant responsible for the presence of proteinuria in late mid-aged male workers, while HbA1c and BMI were found in the junior subgroup. By algorithmic analysis, this study provides a comprehensive hierarchical model for better understanding of the correlates of proteinuria and sleep apnea.
authors: Department of Physical Medicine and Rehabilitation, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung, Taiwan.|Center of Sleep Medicine, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung, Taiwan.|Institute of Medicine, Chung-Shan Medical University, Taichung, Taiwan.
authors: Hua
authors: H
authors: Ting
authors: Institute of Medicine, Chung-Shan Medical University, Taichung, Taiwan.|Department of Anesthesiology, Chung-Shan Medical University Hospital, Taichung, Taiwan.
authors: Cher-Ming
authors: CM
authors: Liou
authors: Institute of Occupational Safety and Health Council of Labor Affairs, Executive Yuan, Taipei, Taiwan.|Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.
authors: Tung-Sheng
authors: TS
authors: Shih
authors: Center of Sleep Medicine, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung, Taiwan.|Department of Psychology, National Chengchi University, Taipei, Taiwan.
authors: Chih-Huan
authors: CH
authors: Wang
authors: Center of Sleep Medicine, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung, Taiwan.|Institute of Medicine, Chung-Shan Medical University, Taichung, Taiwan.
authors: Shu-Yun
authors: SY
authors: Chang
authors: Center of Sleep Medicine, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung, Taiwan.
authors: Ai-Hui
authors: AH
authors: Chung
authors: Center of Sleep Medicine, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung, Taiwan.
authors: Jia-Fei
authors: JF
authors: Lee
authors: Department of Public Health, Chung-Shan Medical University, Taichung, Taiwan.
authors: Lee
authors: L
authors: Wang
authors: Center of Sleep Medicine, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung, Taiwan.|Department of Medical Image and Radiological Sciences, Chung-Shan Medical University, Taichung, Taiwan.
authors: Ren-Jing
authors: RJ
authors: Huang
authors: Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, 91 Hsueh-Shih Road, Taichung, 40202, Taiwan. shinda@mail.cmu.edu.tw.|Department of Healthcare Administration, Asia University, Taichung, Taiwan. shinda@mail.cmu.edu.tw.|School of Rehabilitation Medicine, Shanghai University of TCM, Shanghai, China. shinda@mail.cmu.edu.tw.
authors: Shin-Da
authors: SD
authors: Lee
mesh_terms: D000367:Age Factors; D000465:Algorithms; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003663:Decision Trees; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D017286:Polysomnography; D011507:Proteinuria / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D012307:Risk Factors; D057185:Sedentary Behavior; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D013223:Statistics as Topic; D013624:Taiwan
keywords: Apnea-hypopnea index; Dipstick urinalysis; Metabolic syndrome; Microalbuminuria; Sleep disordered breathing