Driendl Sarah, Baumert Mathias, Arzt Michael, Stark Klaus J, Pec Jan, Sinha Frederick, Kmiec Lukasz, Zeman Florian, Stadler Stefan
Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
Discipline of Biomedical Engineering, School of Electrical and Mechanical Engineering, University of Adelaide, North Terrace, Adelaide, SA 5000, Australia.
Eur J Prev Cardiol. 2025 Apr 28. doi: 10.1093/eurjpc/zwaf259.
Type 2 diabetes (T2D) prevalence is globally increasing and associated with cardiovascular disease. Whether oximetry-derived nocturnal hypoxemic burden (NHB) parameters are associated with incident major adverse cardiovascular events (MACE) in a population with T2D is not known.
Overnight oximetry data from patients enrolled in the DIACORE (DIAbetes COhoRtE) sleep-disordered breathing sub-study, a prospective German cohort study of patients with T2D, was analyzed. NHB as cumulative time spent below 90% oxygen saturation (T90) as well as its composition of T90 attributed to acute desaturations (T90desaturation) and non-specific drifts in oxygen saturation (T90non-specific) was assessed. MACE was defined as a composite outcome of myocardial infarction, stroke, and cardiovascular death. Cox hazard regression analyses adjusted for potential known risk factors for atherosclerosis were conducted.
The analysis population consisted of 1255 participants (41% female, mean age 67 years, mean diabetes duration 9.6 years). After a median follow-up of 6.5 years, a MACE occurred in 149 (12%) patients. T90, but not apnea-hypopnea index, was significantly associated with an increased risk of incident MACE by 48% independently of other known risk factors for atherosclerosis (Quartile 4 vs. Q1-3 adjusted HR 1.48, 95% CI [1.04; 2.12], p=0.032). In particular, T90non-specific contributed to the elevated risk for incident MACE (Q4 vs. Q1-3 adjusted HR 1.62, 95% CI [1.14-2.30], p=0.007).
In the present study, NHB was associated with MACE in patients with T2D and can be easily measured using oximetry. Further investigations are warranted to establish T90 reduction as a clinically meaningful treatment target.
2型糖尿病（T2D）的患病率在全球范围内呈上升趋势，且与心血管疾病相关。目前尚不清楚在2型糖尿病患者群体中，通过血氧饱和度测定得出的夜间低氧血症负担（NHB）参数是否与主要不良心血管事件（MACE）的发生有关。
对DIACORE（糖尿病队列研究）睡眠呼吸障碍子研究中纳入的患者的夜间血氧饱和度测定数据进行分析，该研究是一项针对2型糖尿病患者的前瞻性德国队列研究。评估NHB，即血氧饱和度低于90%的累计时间（T90），以及T90中归因于急性血氧饱和度下降（T90desaturation）和血氧饱和度非特异性波动（T90non-specific）的组成部分。MACE被定义为心肌梗死、中风和心血管死亡的综合结果。进行了Cox风险回归分析，并对动脉粥样硬化的潜在已知风险因素进行了校正。
分析人群包括1255名参与者（41%为女性，平均年龄67岁，平均糖尿病病程9.6年）。在中位随访6.5年后，149名（12%）患者发生了MACE。T90，而非呼吸暂停低通气指数，与MACE发生风险增加显著相关，独立于其他已知的动脉粥样硬化风险因素，增加了48%（四分位数4与Q1-3相比，校正后HR 1.48，95%CI[1.04；2.12]，p=0.032）。特别是，T90non-specific导致MACE发生风险升高（Q4与Q1-3相比，校正后HR 1.62，95%CI[1.14-2.30]，p=0.007）。
在本研究中，NHB与2型糖尿病患者的MACE相关，并且可以通过血氧饱和度测定轻松测量。有必要进行进一步研究，以确定降低T90作为一个具有临床意义的治疗靶点。
Zotero 插件