Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Diabetes Res. 2018 Mar 7;2018:9269170. doi: 10.1155/2018/9269170. eCollection 2018.
This study explored the relationship between obstructive sleep apnea (OSA) and the presence of any diabetes-related complications in type 2 diabetes and whether this was mediated by hypertension. Secondly, the relationship between OSA severity and estimated glomerular filtration rate (eGFR) was investigated. A total of 131 patients participated. OSA was diagnosed using a home monitor, and severity was measured by apnea-hypopnea index (AHI) and oxygen desaturation index (ODI). OSA was found in 75.6% of the participants, 40.5% with moderate-to-severe degree. Any diabetes-related complications (retinopathy, neuropathy, nephropathy, or coronary artery disease) were present in 55.5%, and 70.2% of the participants had hypertension. Mediation analysis indicated that, compared to those with mild or no OSA, those with moderate-to-severe OSA were 3.05 times more likely to have any diabetes-related complications and that this relationship was mediated by the presence of hypertension. After adjusting for confounders, ODI ( = -0.036, = 0.041), but not AHI, was significantly associated with lower eGFR. In conclusion, moderate-to-severe OSA was related to the presence of any diabetes-related complications in type 2 diabetes, and the relationship was mediated by hypertension. The severity of intermittent hypoxia was associated with lower eGFR. Whether OSA treatment will delay or reduce diabetes-related complications should be investigated.
本研究探讨了阻塞性睡眠呼吸暂停（OSA）与 2 型糖尿病中任何糖尿病相关并发症的存在之间的关系，以及这种关系是否由高血压介导。其次，研究了 OSA 严重程度与估计肾小球滤过率（eGFR）之间的关系。共有 131 名患者参与。使用家庭监测器诊断 OSA，并通过呼吸暂停-低通气指数（AHI）和氧减饱和指数（ODI）来测量严重程度。研究参与者中有 75.6%患有 OSA，其中 40.5%为中重度。任何糖尿病相关并发症（视网膜病变、神经病变、肾病或冠状动脉疾病）的发生率为 55.5%，70.2%的参与者患有高血压。中介分析表明，与轻度或无 OSA 的患者相比，中重度 OSA 的患者发生任何糖尿病相关并发症的可能性是前者的 3.05 倍，而这种关系是由高血压引起的。调整混杂因素后，ODI（ = -0.036， = 0.041），而不是 AHI，与较低的 eGFR 显著相关。总之，中重度 OSA 与 2 型糖尿病中任何糖尿病相关并发症的存在有关，这种关系由高血压介导。间歇性低氧的严重程度与较低的 eGFR 有关。是否需要进行 OSA 治疗以延缓或减少糖尿病相关并发症，尚需进一步研究。
