2型糖尿病男性和女性中阻塞性睡眠呼吸暂停严重程度与小梁骨评分之间关系的差异。
The differences in the relationship between obstructive sleep apnea severity and trabecular bone score in men and women with type 2 diabetes.
作者信息
Nimitphong Hataikarn, Siwasaranond Nantaporn, Sritara Chanika, Saetung Sunee, Chailurkit La-Or, Chirakalwasan Naricha, Ongphiphadhanakul Boonsong, Reutrakul Sirimon
机构信息
Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
出版信息
J Clin Transl Endocrinol. 2019 May 2;16:100193. doi: 10.1016/j.jcte.2019.100193. eCollection 2019 Jun.
AIMS
Type 2 diabetes mellitus (T2DM) and obstructive sleep apnea (OSA) may adversely affect bone. Gender is a well-established factor influencing bone health. We investigated the impact of OSA on bone mineral density (BMD) and trabecular bone score (TBS) in T2DM.
METHODS
Eighty-one T2DM patients [33 men and 48 women] participated. OSA was diagnosed using an overnight monitor, with its severity assessed by an apnea hypopnia index (pAHI). The measurements of hypoxia, including the percentage of total sleep time in which oxygen saturation remains below 90% (pT90), the oxygen desaturation index (pODI) and minimum O (min O), were reported. Lumbar spine (L1-4) and femoral neck (FN) BMD were measured using dual-energy X-ray absorptiometry (DXA). TBS was computed from DXA images.
RESULTS
Sixty-five patients (80.2%) had OSA. pAHI, pT90, pODI and min O were not correlated to L1-4 BMD, FN BMD or TBS in all participants by multiple regression analyses adjusting for age, gender and BMI. However, an interaction between gender and pAHI, and gender and pODI were significantly associated with TBS (b = 0.003, = 0.034 and b = 0.004, = 0.046, respectively). We therefore reassessed an association between pAHI or pODI and TBS separately between men and women. After adjusting for age and BMI, more severe OSA (higher pAHI) and higher pODI significantly associated with lower TBS (b = -0.002, = 0.034 and b = -0.003, = 0.021, respectively) in men. On the other hand, higher pAHI non-significantly associated with better trabecular microarchitecture as indicated by higher TBS (b = 0.002, = 0.059) in women. When considered only postmenopausal (n = 33), higher pAHI and higher pODI were significantly associated with higher TBS (b = 0.004, = 0.003 and b = 0.004, = 0.008, respectively).
CONCLUSIONS
In T2DM patients, there is a complex interrelationship among OSA severity, gender and TBS. More severe OSA predicted lower TBS in men, but predicted higher TBS in postmenopausal women.
目的
2型糖尿病（T2DM）和阻塞性睡眠呼吸暂停（OSA）可能会对骨骼产生不利影响。性别是影响骨骼健康的一个公认因素。我们研究了OSA对T2DM患者骨密度（BMD）和骨小梁骨评分（TBS）的影响。
方法
81例T2DM患者[33例男性和48例女性]参与研究。使用夜间监测仪诊断OSA，并通过呼吸暂停低通气指数（pAHI）评估其严重程度。报告了低氧测量结果，包括氧饱和度低于90%的总睡眠时间百分比（pT90）、氧去饱和指数（pODI）和最低氧饱和度（min O）。使用双能X线吸收法（DXA）测量腰椎（L1-4）和股骨颈（FN）的BMD。从DXA图像计算TBS。
结果
65例患者（80.2%）患有OSA。通过对年龄、性别和体重指数进行校正的多元回归分析，在所有参与者中，pAHI、pT90、pODI和min O与L1-4 BMD、FN BMD或TBS均无相关性。然而，性别与pAHI以及性别与pODI之间的相互作用与TBS显著相关（分别为b = 0.003，P = 0.034和b = 0.004，P = 0.046）。因此，我们分别重新评估了男性和女性中pAHI或pODI与TBS之间的关联。在对年龄和体重指数进行校正后，更严重的OSA（更高的pAHI）和更高的pODI与男性较低的TBS显著相关（分别为b = -0.002，P = 0.034和b = -0.003，P = 0.021）。另一方面，在女性中，较高的pAHI与较高的TBS所表明的更好的骨小梁微结构无显著相关性（b = 0.002，P = 0.059）。仅考虑绝经后女性（n = 33）时，较高的pAHI和较高的pODI与较高的TBS显著相关（分别为b = 0.004，P = 0.003和b = 0.004，P = 0.008）。
结论
在T2DM患者中，OSA严重程度、性别和TBS之间存在复杂的相互关系。更严重的OSA在男性中预示着较低的TBS，但在绝经后女性中预示着较高的TBS。
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