Division of Health Research, Lancaster University, Lancaster, United Kingdom.
Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates.
Front Endocrinol (Lausanne). 2024 Sep 4;15:1373919. doi: 10.3389/fendo.2024.1373919. eCollection 2024.
The association between obstructive sleep apnea (OSA) and type 2 diabetes mellitus (T2DM) has been explored in various studies, revealing inconsistent correlations that impact therapeutic effectiveness. This heterogeneity in findings requires further exploration to understand what may be driving this. Therefore, this study focuses on systematically reviewing the data, classification of variables, and analytical approach to understand if and how this may be contributing to the mixed findings. This review aims to provide insights that can enhance the generalisability of future research findings.
A comprehensive electronic search was conducted, including EMBASE, MEDLINE, PsycINFO, CINAHL, Web of Science Core Collection, Scopus and specialised sleep journals. The included studies were observational studies published in English from 2011 onwards, involving adults above 18 years with OSA and T2DM or prediabetes, and included a control group. Exclusions were pregnant women, interventional studies, randomised trials, systematic reviews, conference abstracts, case studies and studies without a control group or only with descriptive analysis.
We reviewed 23 studies that met the inclusion criteria. Among cohort studies, 54% did not report attrition rates, and 52% did not detail methods for handling missing data in all studies. Nine studies (39%) predominantly included male participants. Objective measures were prevalent in assessing OSA, with 11 using home portable sleep monitors and four employing clinic polysomnography, though only three validated home sleep monitors. The apnea-hypopnea index was commonly used to define OSA severity, with six studies adapting the American Academy of Sleep Medicine criteria. Two studies utilised validated self-report questionnaires for OSA symptoms. T2DM diagnosis methods varied, with 17 studies using blood samples, two relying only on self-reporting, and four confirmed diagnosis via medical records.
The variability in sample characteristics, data quality, and variable coding may contribute to the mixed finding. This review identifies gaps in using the standardised measures, reporting attrition rates, handling missing data, and including both sexes. Addressing these issues is crucial to enhancing future research generalisability. Standardising diagnostic criteria, considering clinical and sociodemographic factors, and ensuring inclusivity in study populations are essential for advancing understanding and treatment strategies for OSA and T2DM.
https://www.crd.york.ac.uk/prospero, identifier CRD42023397547.
阻塞性睡眠呼吸暂停（OSA）与 2 型糖尿病（T2DM）之间的关联已在各种研究中进行了探讨，结果显示存在不一致的相关性，这影响了治疗效果。这种研究结果的异质性需要进一步探讨，以了解可能是什么导致了这种情况。因此，本研究重点系统地回顾数据、变量分类和分析方法，以了解这是否以及如何导致研究结果出现差异。本综述旨在提供可增强未来研究结果普遍性的见解。
进行了全面的电子检索，包括 EMBASE、MEDLINE、PsycINFO、CINAHL、Web of Science 核心合集、Scopus 和专门的睡眠期刊。纳入的研究为 2011 年以后发表的以成年人（年龄大于 18 岁）为对象、以 OSA 和 T2DM 或糖尿病前期为研究对象并设有对照组的观察性研究。排除了孕妇、干预性研究、随机试验、系统评价、会议摘要、病例研究以及无对照组或仅有描述性分析的研究。
我们综述了 23 项符合纳入标准的研究。在队列研究中，54%未报告失访率，52%未详细说明所有研究中处理缺失数据的方法。9 项研究（39%）主要纳入男性参与者。客观测量在评估 OSA 中较为普遍，其中 11 项使用家庭便携式睡眠监测仪，4 项使用诊所多导睡眠图，但只有 3 项使用了经过验证的家庭睡眠监测仪。呼吸暂停低通气指数常用于定义 OSA 严重程度，其中 6 项研究采用了美国睡眠医学学会的标准。有 2 项研究使用了经过验证的 OSA 症状自评问卷。T2DM 的诊断方法多种多样，17 项研究使用了血液样本，2 项仅依赖于自我报告，4 项则通过病历确认诊断。
样本特征、数据质量和变量编码的差异可能导致了研究结果的不一致。本综述发现，在使用标准化测量、报告失访率、处理缺失数据以及纳入男女两性方面存在不足。解决这些问题对于提高未来研究的普遍性至关重要。标准化诊断标准、考虑临床和社会人口学因素以及确保研究人群的包容性，对于推进对 OSA 和 T2DM 的理解和治疗策略至关重要。
https://www.crd.york.ac.uk/prospero，注册号 CRD42023397547。
