持续气道正压通气依从性与 2 型糖尿病合并阻塞性睡眠呼吸暂停患者并发症的关系。

Association of continuous positive airway pressure adherence with complications in patients with type 2 diabetes and obstructive sleep apnea.

机构信息

University of Illinois at Chicago, Chicago, Illinois.

Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.

出版信息

J Clin Sleep Med. 2021 Aug 1;17(8):1563-1569. doi: 10.5664/jcsm.9248.

DOI:10.5664/jcsm.9248

PMID:34313215

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8656901/

Abstract

STUDY OBJECTIVES

To explore the association of continuous positive airway pressure (CPAP) adherence with clinical outcomes in patients with type 2 diabetes and obstructive sleep apnea in a real-world setting.

METHODS

This was a retrospective study of patients with type 2 diabetes diagnosed with obstructive sleep apnea between 2010 and 2017. CPAP adherence (usage for ≥ 4 h/night for ≥ 70% of nights) was determined from the first CPAP report following the polysomnography. Data including estimated glomerular filtration rate, hemoglobin A1c, systolic and diastolic blood pressure, lipid panel, and incident cardiovascular/peripheral vascular/cerebrovascular events were extracted from medical records. Mixed-effects linear regression modeling of longitudinal repeated measures within patients was utilized for continuous outcomes, and logistic regression modeling was used for binary outcomes. Models were controlled for age, sex, body mass index, medications, and baseline levels of outcomes.

RESULTS

Of the 1,295 patients, 260 (20.7%) were CPAP adherent, 318 (24.5%) were CPAP nonadherent, and 717 (55.3%) had insufficient data. The follow-up period was, on average, 2.5 (1.7) years. Compared to those who were CPAP nonadherent, those who were adherent had a significantly lower systolic blood pressure (β = -1.95 mm Hg, = .001) and diastolic blood pressure (β = -2.33 mm Hg, < .0001). Among the patients who were CPAP adherent, a 17% greater CPAP adherence was associated with a 2 mm Hg lower systolic blood pressure. Lipids, hemoglobin A1c, estimated glomerular filtration rate, and incident cardiovascular/peripheral vascular/cerebrovascular events were not different between the 2 groups.

CONCLUSIONS

Achieving CPAP adherence in patients with type 2 diabetes and obstructive sleep apnea was associated with significantly lower blood pressure. Greater CPAP use within patients who were adherent was associated with lower systolic blood pressure.

CITATION

Sheth U, Monson RS, Prasad B, et al. Association of continuous positive airway pressure adherence with complications in patients with type 2 diabetes and obstructive sleep apnea. 2021;17(8):1563-1569.

摘要

研究目的

在真实环境中探讨持续气道正压通气（CPAP）依从性与 2 型糖尿病合并阻塞性睡眠呼吸暂停患者临床结局的相关性。

方法

这是一项回顾性研究，纳入了 2010 年至 2017 年间被诊断为阻塞性睡眠呼吸暂停的 2 型糖尿病患者。CPAP 依从性（首次多导睡眠图报告后每晚使用 CPAP 时间≥4 小时且≥70%的夜晚）通过 CPAP 报告确定。从病历中提取包括估算肾小球滤过率、糖化血红蛋白、收缩压和舒张压、血脂谱以及心血管/周围血管/脑血管事件的发生等数据。采用患者内纵向重复测量的混合效应线性回归模型分析连续结果，采用二项逻辑回归模型分析二项结果。模型中控制了年龄、性别、体重指数、药物以及结局的基线水平。

结果

在 1295 名患者中，260 名（20.7%）患者 CPAP 依从性较好，318 名（24.5%）患者 CPAP 依从性较差，717 名（55.3%）患者数据不足。平均随访时间为 2.5（1.7）年。与 CPAP 依从性较差的患者相比，CPAP 依从性较好的患者收缩压（β=-1.95mmHg， =.001）和舒张压（β=-2.33mmHg， <.0001）明显更低。在 CPAP 依从性较好的患者中，CPAP 使用率增加 17%与收缩压降低 2mmHg 相关。两组间血脂、糖化血红蛋白、估算肾小球滤过率和心血管/周围血管/脑血管事件的发生率无差异。