Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA; Johns Hopkins University, School of Medicine, USA.
Texas A&M University, Department of Statistics, USA.
Sleep Med. 2022 Jul;95:105-111. doi: 10.1016/j.sleep.2022.04.007. Epub 2022 Apr 23.
Continuous glucose monitoring (CGM) provides temporal data on glycemic variability, a predictor of outcomes related to type 2 diabetes mellitus. The current study sought to determine whether CGM-derived metrics in patients with type 2 diabetes are different in moderate-to-severe versus mild obstructive sleep apnea (OSA).
In adults with type 2 diabetes, home testing was used of assess the presence of OSA. CGM data were collected for at least 7 days in those with an oxygen desaturation index (ODI) ≥ 5 events/hr. The study sample was divided into mild (ODI: 5.0-14.9 events/hr) and moderate-to-severe OSA (ODI ≥15 events/hr). Actigraphy was used to distinguish the wake and sleep periods. CGM-derived metrics were compared between the two groups using multivariable regression models.
Compared to mild OSA, patients with moderate-to-severe OSA had higher mean glucose levels during sleep (adjusted difference 8.4 mg/dL; p-value: 0.03) and wakefulness (adjusted difference 7.1 mg/dL; p-value: 0.06). Moderate-to-severe OSA patients also had lower odds for having their glucose values within the acceptable range during wakefulness than those with mild OSA (adjusted odds ratio of 0.63; p-value: 0.02). The mean amplitude of glycemic excursion and standard deviation of the rate of change in glucose values (SD-ROC) were higher in moderate-to-severe than mild OSA, but only during wakefulness. Sex modified the association between OSA severity and SD-ROC, but not the other CGM-derived metrics.
In patients with type 2 diabetes, moderate-to-severe OSA is associated with greater abnormalities in CGM-derived metrics than mild OSA with notable differences between sleep and wakefulness.
连续血糖监测（CGM）提供了与 2 型糖尿病相关的血糖变异性的时间数据，而血糖变异性是结局的预测因子。本研究旨在确定 2 型糖尿病患者中 CGM 衍生指标在中重度与轻度阻塞性睡眠呼吸暂停（OSA）之间是否存在差异。
在患有 2 型糖尿病的成年人中，使用家庭测试来评估 OSA 的存在。在 ODI≥5 事件/小时的患者中至少收集 7 天的 CGM 数据。研究样本分为轻度（ODI：5.0-14.9 事件/小时）和中重度 OSA（ODI≥15 事件/小时）。使用活动记录仪来区分清醒和睡眠期。使用多变量回归模型比较两组之间的 CGM 衍生指标。
与轻度 OSA 相比，中重度 OSA 患者在睡眠期间（校正差异 8.4mg/dL；p 值：0.03）和清醒期间（校正差异 7.1mg/dL；p 值：0.06）的平均血糖水平更高。中重度 OSA 患者在清醒期间血糖值在可接受范围内的可能性也低于轻度 OSA 患者（校正优势比 0.63；p 值：0.02）。中重度 OSA 患者的血糖波动幅度均值和血糖变化率标准差（SD-ROC）高于轻度 OSA 患者，但仅在清醒期间。性别修饰了 OSA 严重程度与 SD-ROC 之间的关联，但不是其他 CGM 衍生指标。
在 2 型糖尿病患者中，中重度 OSA 与 CGM 衍生指标的异常程度高于轻度 OSA 相关，且在睡眠和清醒期间存在显著差异。
