Institute of Clinical Sciences, University of Birmingham, Birmingham, UK.
Respiratory Therapy Department, Taibah University, Medina, Saudi Arabia.
Diabetologia. 2022 Aug;65(8):1353-1363. doi: 10.1007/s00125-022-05714-5. Epub 2022 May 24.
AIMS/HYPOTHESIS: People with type 2 diabetes are at increased risk of developing obstructive sleep apnoea. However, it is not known whether people with type 1 diabetes are also at an increased risk of obstructive sleep apnoea. This study aimed to examine whether people with type 1 diabetes are at increased risk of incident obstructive sleep apnoea compared with a matched cohort without type 1 diabetes.
We used a UK primary care database, The Health Improvement Network (THIN), to perform a retrospective cohort study between January 1995 and January 2018 comparing sleep apnoea incidence between patients with type 1 diabetes (exposed) and without type 1 diabetes (unexposed) (matched for age, sex, BMI and general practice). The outcome was incidence of obstructive sleep apnoea. Baseline covariates and characteristics were assessed at the start of the study based on the most recent value recorded prior to the index date. The Cox proportional hazards regression model was used to estimate unadjusted and adjusted hazard ratios, based on a complete-case analysis.
In total, 34,147 exposed and 129,500 matched unexposed patients were included. The median follow-up time was 5.43 years ((IQR 2.19-10.11), and the mean BMI was 25.82 kg/m (SD 4.33). The adjusted HR for incident obstructive sleep apnoea in patients with type 1 diabetes vs those without type 1 diabetes was 1.53 (95% CI 1.25, 1.86; p<0.001). Predictors of incident obstructive sleep apnoea in patients with type 1 diabetes were older age, male sex, obesity, being prescribed antihypertensive or lipid-lowering drugs, atrial fibrillation and depression.
CONCLUSIONS/INTERPRETATION: Individuals with type 1 diabetes are at increased risk of obstructive sleep apnoea compared with people without diabetes. Clinicians should suspect obstructive sleep apnoea in patients with type 1 diabetes if they are old, have obesity, are male, have atrial fibrillation or depression, or if they are taking lipid-lowering or antihypertensive drugs.
目的/假设：2 型糖尿病患者发生阻塞性睡眠呼吸暂停的风险增加。然而，目前尚不清楚 1 型糖尿病患者是否也存在发生阻塞性睡眠呼吸暂停的风险增加。本研究旨在评估与无 1 型糖尿病的匹配队列相比，1 型糖尿病患者发生阻塞性睡眠呼吸暂停的风险是否增加。
我们使用英国初级保健数据库（The Health Improvement Network，THIN），于 1995 年 1 月至 2018 年 1 月期间进行了一项回顾性队列研究，比较了 1 型糖尿病（暴露组）和无 1 型糖尿病（未暴露组）患者之间的睡眠呼吸暂停发生率（根据指数日期前最近一次记录的年龄、性别、BMI 和全科医生进行匹配）。结局为阻塞性睡眠呼吸暂停的发生率。基于完整病例分析，使用 Cox 比例风险回归模型评估了研究开始时的基线协变量和特征。
共纳入 34147 例暴露患者和 129500 例匹配的未暴露患者。中位随访时间为 5.43 年（IQR 2.19-10.11），平均 BMI 为 25.82kg/m（SD 4.33）。与无 1 型糖尿病的患者相比，1 型糖尿病患者发生阻塞性睡眠呼吸暂停的调整后 HR 为 1.53（95%CI 1.25,1.86；p<0.001）。1 型糖尿病患者发生阻塞性睡眠呼吸暂停的预测因素为年龄较大、男性、肥胖、服用抗高血压或降脂药物、心房颤动和抑郁。
结论/解释：与无糖尿病的患者相比，1 型糖尿病患者发生阻塞性睡眠呼吸暂停的风险增加。如果患者年龄较大、肥胖、为男性、患有心房颤动或抑郁症，或正在服用降脂或抗高血压药物，临床医生应怀疑其患有阻塞性睡眠呼吸暂停。
Zotero 插件