Gutiérrez-Carrasquilla Liliana, López-Cano Carolina, Sánchez Enric, Barbé Ferran, Dalmases Mireia, Hernández Marta, Campos Angela, Gaeta Anna Michaela, Carmona Paola, Hernández Cristina, Simó Rafael, Lecube Albert
Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) research group, IRBLleida, University of Lleida, 25198 Lleida, Spain.
Respiratory Department, University Hospital Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, IRBLleida, University of Lleida, 25198 Lleida, Spain.
J Clin Med. 2020 Apr 4;9(4):1022. doi: 10.3390/jcm9041022.
Type 2 diabetes exerts a negative impact on sleep breathing. It is unknown whether a long-term improvement in glycemic control ameliorates this effect. We conducted an interventional study with 35 patients with type 2 diabetes and obstructive sleep apnea (OSA) to explore this. At home, sleep breathing parameters were assessed at baseline and after a 4-month period in which antidiabetic therapy was intensified. Patients who decreased their body mass index ≥2kg/m were excluded. Those with an HbA1c reduction ≥0.5% were considered good responders ( = 24). After the follow-up, good responders exhibited an improvement in the apnea-hypopnea index (AHI: 26-1 (95% IC: 8.6-95.0) vs. 20.0 (4.0-62.4) events/hour, = 0.002) and in time with oxygen saturation below 90% (CT90: 13.3 (0.4-69.0) vs. 8.1 (0.4-71.2) %, = 0.002). No changes were observed in the group of non-responders ( = 0.722 and = 0.138, respectively). The percentage of moderate and severe OSA decreased among good responders ( = 0.040). In the wider population, the change in HbA1c correlated positively to decreases in AHI (r = 0.358, = 0.035) and negatively to increases in the minimum arterial oxygen saturation (r = -0.386, = 0.039). Stepwise multivariate regression analysis showed that baseline AHI and the absolute change in HbA1c independently predicted decreased AHI (R = 0.496). The improvement of glycemic control exerts beneficial effects on sleep breathing parameters in type 2 diabetes, which cannot be attributed merely to weight loss.
2型糖尿病对睡眠呼吸有负面影响。目前尚不清楚血糖控制的长期改善是否能改善这种影响。我们对35例2型糖尿病合并阻塞性睡眠呼吸暂停（OSA）患者进行了一项干预性研究以探讨这一问题。在家中，在基线时以及强化抗糖尿病治疗4个月后评估睡眠呼吸参数。体重指数降低≥2kg/m²的患者被排除。糖化血红蛋白（HbA1c）降低≥0.5%的患者被视为良好应答者（n = 24）。随访后，良好应答者的呼吸暂停低通气指数（AHI：26.1（95%置信区间：8.6 - 95.0）次/小时 vs. 20.0（4.0 - 62.4）次/小时，P = 0.002）以及血氧饱和度低于90%的时间（CT90：13.3（0.4 - 69.0）% vs. 8.1（0.4 - 71.2）%，P = 0.002）均有改善。无应答者组未观察到变化（分别为P = 0.722和P = 0.138）。良好应答者中中度和重度OSA的比例下降（P = 0.040）。在更广泛的人群中，HbA1c的变化与AHI的降低呈正相关（r = 0.358，P = 0.035），与最低动脉血氧饱和度的升高呈负相关（r = -0.386，P = 0.039）。逐步多元回归分析显示，基线AHI和HbA1c的绝对变化独立预测AHI降低（R = 0.496）。血糖控制的改善对2型糖尿病患者的睡眠呼吸参数有有益影响，这不能仅仅归因于体重减轻。
