Du Chunmin, He Chunmei, Dong Lianqin, Zheng Silan, Wang Wengui, Zheng Caiyu, Wang Shunhua, Lin MingZhu, Yang Shuyu, Li Xuejun, Li Zhibin, Liu Changqin
School of Medicine, Xiamen University, Xiamen, China.
Xiamen Diabetes Institute, The First Affiliated Hospital, Xiamen University, Xiamen, China.
Endocrine. 2020 Feb;67(2):363-373. doi: 10.1007/s12020-020-02192-w. Epub 2020 Jan 11.
The relationship between obstructive sleep apnea (OSA) and diabetic microvascular complications (DMC) are controversial. Whether low education is associated with increased risk of DMC independently of poor lifestyles are currently unknown. The aim of this study is to explore the independent associations of different PSG index and educational attainment with risks of DR, DKD, and DPN.
A cross-sectional study of 330 patients with T2DM who underwent overnight polysomnography (PSG) tests. Multivariable logistic regression analysis was performed to determine the associations of PSG index and educational attainments with DR, DKD, and DPN.
The prevalence rates of DMC were 30.6% for DR, 24.9% for DKD, and 64.6% for DPN. All PSG index (AHI, REM-AHI, NREM-AHI, the severity of OSAS, ODI, MAI, and lowest SaO) were not significantly associated with risks of DR, DKD, or DPN with adjustment for potential confounding factors. Subjects with increasing educational attainments showed significantly decreased prevalence rates of DR (42.6, 27.3, and 21.3%, p = 0.005), DKD (31.7, 25.3, and 14.7%, p = 0.035) and DPN (74.3, 63.6, and 53.3%, p = 0.015), respectively. Logistic regression analyses showed that educational attainment of primary or below showed significantly increased risks of DR (OR (95% CIs): 3.596 (1.453-8.899, p = 0.006)) and DKD (OR (95% CIs): 3.201 (1.244-8.242, p = 0.016)) as compared with that of college or above. There were significant trends of lower educational attainment with increased risks of DR and DKD (p values < 0.05).
PSG index were not significantly associated with DMC. But lower education was significantly associated with increased risks of DR and DKD, and strategies to prevent DMC for those with low education should be strengthened.
阻塞性睡眠呼吸暂停（OSA）与糖尿病微血管并发症（DMC）之间的关系存在争议。目前尚不清楚低教育水平是否独立于不良生活方式而与DMC风险增加相关。本研究的目的是探讨不同的多导睡眠图（PSG）指标和教育程度与糖尿病视网膜病变（DR）、糖尿病肾病（DKD）和糖尿病周围神经病变（DPN）风险的独立关联。
对330例接受过夜多导睡眠图（PSG）检查的2型糖尿病患者进行横断面研究。进行多变量逻辑回归分析以确定PSG指标和教育程度与DR、DKD和DPN的关联。
DMC的患病率分别为DR 30.6%、DKD 24.9%和DPN 64.6%。在对潜在混杂因素进行调整后，所有PSG指标（呼吸暂停低通气指数（AHI）、快速眼动期AHI、非快速眼动期AHI、阻塞性睡眠呼吸暂停低通气综合征（OSAS）严重程度、氧减指数（ODI）、微觉醒指数（MAI）和最低血氧饱和度（SaO））与DR、DKD或DPN的风险均无显著关联。教育程度提高的受试者DR（42.6%、27.3%和21.3%，p = 0.005）、DKD（31.7%、25.3%和14.7%，p = 0.035）和DPN（74.3%、63.6%和53.3%，p = 0.015）的患病率显著降低。逻辑回归分析表明，与大专及以上学历相比，小学及以下学历的DR（比值比（95%置信区间）：3.596（1.453 - 8.899，p = 0.006））和DKD（比值比（95%置信区间）：3.201（1.244 - 8.242，p = 0.016））风险显著增加。教育程度较低与DR和DKD风险增加存在显著趋势（p值<0.05）。
PSG指标与DMC无显著关联。但低教育水平与DR和DKD风险增加显著相关，应加强针对低教育水平人群预防DMC的策略。
