睡眠呼吸紊乱与糖尿病足溃疡患者伤口愈合的相关性。
Association of sleep-disordered breathing and wound healing in patients with diabetic foot ulcers.
机构信息
Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China.
Contributed equally.
出版信息
J Clin Sleep Med. 2021 May 1;17(5):909-916. doi: 10.5664/jcsm.9088.
STUDY OBJECTIVES
Sleep-disordered breathing (SDB) is prevalent and associated with an increased risk of morbidity and mortality. However, whether SDB has an adverse impact on wound healing in patients with diabetic foot ulcers (DFUs) is uncertain. The purpose of this study was to investigate the association of SDB with wound healing in patients with DFUs.
METHODS
A total of 167 patients with DFUs were enrolled between July 2013 and June 2019 at West China Hospital (Chengdu, China) to assess the association of SDB with wound healing, ulcer recurrence, and all-cause mortality.
RESULTS
Whereas there was no significant association between apnea-hypopnea index (AHI) and wound healing, total sleep time (per hour: hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.01-1.30; P = .029), sleep efficiency (per 10%: HR, 1.20; 95% CI, 1.04-1.37; P = .012), and wakefulness after sleep onset (per 30 minutes: HR, 0.89; 95% CI, 0.82-0.97; P = .008) were associated with wound healing. Total sleep time (per hour: odds ratio, 0.71; 95% CI, 0.51-0.97; P = .035) and sleep efficiency (per 10%: odds ratio, 0.68; 95% CI, 0.47-0.97; P = .033) were also associated with ulcer recurrence. Mean oxygen saturation (per 3%: HR, 0.68; 95% CI, 0.49-0.94; P = .021) and percentage of sleep time with oxygen saturation < 90% (per 10%: HR, 1.25; 95% CI, 1.03-1.53; P = .026) were significantly associated with mortality.
CONCLUSIONS
SDB is highly prevalent in patients with DFUs but its severity, as conventionally measured by AHI, is not associated with wound healing. Sleep fragmentation and hypoxemia are stronger predictors of poor wound healing, high ulcer recurrence, and increased risk of death in patients with DFUs.
研究目的
睡眠呼吸障碍（SDB）较为普遍，且与发病率和死亡率的增加相关。然而，SDB 是否对糖尿病足溃疡（DFUs）患者的伤口愈合有不良影响尚不确定。本研究旨在探讨 SDB 与 DFUs 患者伤口愈合之间的关系。
方法
2013 年 7 月至 2019 年 6 月，华西医院（成都）共纳入 167 例 DFUs 患者，评估 SDB 与伤口愈合、溃疡复发和全因死亡率之间的关系。
结果
虽然呼吸暂停低通气指数（AHI）与伤口愈合之间无显著相关性，但总睡眠时间（每小时：风险比 [HR]，1.15；95%置信区间 [CI]，1.01-1.30；P =.029）、睡眠效率（每 10%：HR，1.20；95% CI，1.04-1.37；P =.012）和睡眠后觉醒时间（每 30 分钟：HR，0.89；95% CI，0.82-0.97；P =.008）与伤口愈合相关。总睡眠时间（每小时：比值比，0.71；95% CI，0.51-0.97；P =.035）和睡眠效率（每 10%：比值比，0.68；95% CI，0.47-0.97；P =.033）也与溃疡复发相关。平均血氧饱和度（每 3%：HR，0.68；95% CI，0.49-0.94；P =.021）和睡眠中血氧饱和度<90%的时间百分比（每 10%：HR，1.25；95% CI，1.03-1.53；P =.026）与死亡率显著相关。
结论
DFUs 患者中 SDB 较为普遍，但通常通过 AHI 测量的严重程度与伤口愈合无关。睡眠片段化和低氧血症是 DFUs 患者伤口愈合不良、溃疡复发率高和死亡率增加的更强预测因素。
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