Medical College, Yan'an University, Yan'an, Shanxi Province, China.
Cardiology Department of the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
BMC Geriatr. 2021 Sep 25;21(1):508. doi: 10.1186/s12877-021-02461-x.
The prognostic significance of obstructive sleep apnea (OSA) in elderly patients with type 2 diabetes is unclear. The aim of this study was to determine the risk of cardiovascular disease (CVD) and mortality in elderly patients with OSA complicated with type 2 diabetes compared to patients with OSA without type 2 diabetes.
From January 2015 to October 2017, 1113 eligible elderly patients with OSA, no history of cardiovascular, ≥60 years of age, and complete follow-up records were enrolled in this consecutive multicentre prospective cohort study. All patients had completed polysomnography (PSG) examinations. An apnoea-hypopnoea index of ≥5 events per hour recorded by polysomnography was defined as the diagnostic criterion for OSA. We collected baseline demographics, clinical characteristics, sleep parameters and follow-up outcomes. The primary aim of this study was to identify the risk of incident major adverse cardiovascular events (MACE). Secondary outcomes were all-cause mortality, components of MACE and a composite of all events. Kaplan-Meier survival analysis and Cox proportional hazards models were used to evaluate whether type 2 diabetes was associated with incident events.
A total of 266 (23.9%) patients had OSA complicated with type 2 diabetes. MACE occurred in 97 patients during the median 42-month follow-up. Kaplan-Meier survival curves indicated a significant relationship between type 2 diabetes and MACE (log-rank P = 0.003). Multivariable Cox regression analysis showed that type 2 diabetes increased the risk of MACE (HR = 1.64, 95% CI:1.08-2.47, P = 0.019), hospitalisation for unstable angina (HR = 2.11, 95% CI:1.23-3.64, P = 0.007) and a composite of all events in elderly patients with OSA (HR = 1.70, 95% CI:1.17-2.49, P = 0.007). However, there were no significant differences in the incidence of cardiovascular death, all-cause mortality, MI and hospitalisation for heart failure between patients with and without diabetes (P > 0.05). The subgroup analysis demonstrated that females (AHR = 2.46, 95% CI:1.17-5.19, P = 0.018), ≥ 70 years (AHR = 1.95, 95% CI:1.08-3.52, P = 0.027), overweight and obese (AHR = 2.04, 95% CI:1.29-3.33, P = 0.002) with mild OSA (AHR = 2.42, 95% CI: 1.03-5.71, P = 0.044) were at a higher risk for MACE by diabetes.
OSA and type 2 diabetes are interrelated and synergistic with MACE, hospitalisation for unstable angina and a composite of all events development. Overweight and obese females, ≥ 70 years with mild OSA combined with type 2 diabetes presented a significantly high MACE risk.
阻塞性睡眠呼吸暂停（OSA）在 2 型糖尿病老年患者中的预后意义尚不清楚。本研究旨在确定与单纯 OSA 患者相比，合并 2 型糖尿病的 OSA 老年患者发生心血管疾病（CVD）和死亡的风险。
本连续多中心前瞻性队列研究纳入了 2015 年 1 月至 2017 年 10 月期间年龄≥60 岁、有 OSA 病史且无心血管病史、完成了完整随访记录的 1113 名符合条件的老年患者。所有患者均完成了多导睡眠图（PSG）检查。PSG 记录的每小时≥5 次呼吸暂停低通气指数定义为 OSA 的诊断标准。我们收集了基线人口统计学、临床特征、睡眠参数和随访结果。本研究的主要目的是确定主要不良心血管事件（MACE）的发生风险。次要结局为全因死亡率、MACE 各组成部分和所有事件的综合结果。Kaplan-Meier 生存分析和 Cox 比例风险模型用于评估 2 型糖尿病是否与事件发生相关。
共有 266 名（23.9%）患者患有合并 2 型糖尿病的 OSA。在中位随访 42 个月期间，97 名患者发生了 MACE。Kaplan-Meier 生存曲线表明 2 型糖尿病与 MACE 之间存在显著关系（log-rank P=0.003）。多变量 Cox 回归分析表明，2 型糖尿病增加了 MACE 的发生风险（HR=1.64，95%CI：1.08-2.47，P=0.019）、不稳定型心绞痛住院风险（HR=2.11，95%CI：1.23-3.64，P=0.007）和 OSA 老年患者所有事件的综合结果（HR=1.70，95%CI：1.17-2.49，P=0.007）。然而，在有和无糖尿病的患者中，心血管死亡、全因死亡率、心肌梗死和心力衰竭住院率之间没有显著差异（P＞0.05）。亚组分析表明，女性（AHR=2.46，95%CI：1.17-5.19，P=0.018）、≥70 岁（AHR=1.95，95%CI：1.08-3.52，P=0.027）、超重和肥胖（AHR=2.04，95%CI：1.29-3.33，P=0.002）和轻度 OSA（AHR=2.42，95%CI：1.03-5.71，P=0.044）的患者，2 型糖尿病使 MACE 的发生风险更高。
OSA 和 2 型糖尿病相互关联且与 MACE、不稳定型心绞痛住院和所有事件综合结果的发生呈协同关系。超重和肥胖的女性、≥70 岁且合并轻度 OSA 的 2 型糖尿病患者发生 MACE 的风险显著增加。
