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论文摘要

2型糖尿病合并阻塞性睡眠呼吸暂停综合征的临床特点分析

Clinical Characteristics of Patients with Type 2 Diabetes Mellitus and Obstructive Sleep Apnea Syndrome

作者:谭翠霞, 高赟, 王椿等

Author:TAN Cui-xia, GAO Yun, WANG Chun. et al

收稿日期:          年卷(期)页码:2017,48(3):441-445

期刊名称:四川大学学报(医学版)

Journal Name:JOURNAL OF SICHUAN UNIVERSITY (MEDICAL SCIENCE EDITION)

关键字:2型糖尿病 阻塞性睡眠呼吸暂停综合征 并发症

Key words:Type 2 diabetes mellitus Obstructive sleep apnea syndrome Complications

基金项目:

中文摘要

目的比较合并不同程度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea syndrome, OSAS)的2型糖尿病(T2DM )患者的临床特点和慢性并发症的差异。方法收集170例T2DM合并OSAS患者的人口学数据、生化指标和慢性并发症情况等。根据呼吸暂停低通气指数(apnea hypopnea index, AHI),将OSAS患者分为轻度、中度、重度3组,对3组患者的人口学数据、生化指标和慢性并发症发生率进行比较。通过多因素logistic回归分析慢性并发症与OSAS相关关系。结果与轻、中度OSAS相比,T2MD合并重度OSAS患者有更大的腰围(P=0.045)和倾向于有更高的体质量指数(BMI)(P=0.069)。随着OSAS程度的加重,糖尿病周围神经病变的发生率逐渐升高(轻 vs. 中 vs. 重,40.0% vs.42.9% vs.58.8%, P=0.07),糖尿病视网膜病变发生率逐渐升高(12.7% vs. 25.7% vs. 30.0%, P=0.061),但差异均无统计学意义。3组患者之间大血管并发症发生率相似(P均>0.05)。Logistic回归分析显示:调整最低血氧饱和度、性别、年龄、糖尿病病程、糖尿病家族史、BMI和糖化血红蛋白等多种因素后,周围神经病变、慢性肾脏疾病与AHI呈独立相关关系(比值比=1.024, 95%可信区间1.002~1.046,P=0.033;比值比=1.026, 95%可信区间1.004~1.049,P=0.022)。其它微血管并发症和大血管并发症未显示与AHI存在相关关系。结论重度OSAS或可加重T2DM患者糖尿病周围神经病变和视网膜病变的潜在风险,但尚需更多证据支持。

英文摘要

Objective To compare the clinical characteristics and prevalence of chronic complications in type 2 diabetes mellitus (T2DM) patients with various degrees of obstructive sleep apnea syndrome (OSAS). Methods A total of 170 patients with T2DM and OSAS were enrolled in this study. These participants were divided into three groups with low, medium and high apnea-hypopnea index (AHI), respectively. The demographic characteristics, biochemical indicators and chronic complications of the patients in the three groups were compared. Multivariate Logistic regression analysis was performed to determine the associations between chronic complications and OSAS. Results The patients with severe OSAS had higher waist circumference (P=0.045), higher BMI (P=0.069), higher prevalence of diabetic peripheral neuropathy (DPN), and higher prevalence of diabetic retinopathy (DR) than the patients with mild-moderate OSAS. Similar levels of macrovascular complications were found in the three groups (P>0.05). The logistic regression analyses showed that DPN (OR=1.024, 95%CI 1.002-1.046) and chronic kidney disease (OR=1.026, 95%CI 1.004-1.049) were independent predictors of AHI, adjusting for the lowest oxygen saturation, gender, age, diabetic duration, family history of diabetes, BMI, and HbA1c. Other microvascular and macrovascular complications were not predictors of AHI. Conclusion Patients with T2DM and severe OSAS have a higher risk of DPN and DR. Particular attention should be paid to T2DM patients with severe OSAS to prevent complications.

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