Diabetologia:1型糖尿病患者发生阻塞性睡眠呼吸暂停的风险

2022-06-08 从医路漫漫 MedSci原创

已经发现阻塞性睡眠呼吸暂停与道路交通事故风险增加、工作场所生产力降低、二型糖尿病、胰岛素抵抗、高血压、CVD、生活质量降低和死亡风险增加相关。

背景:阻塞性睡眠呼吸暂停常见,在高收入国家影响10%的女性和20%的男性。阻塞性睡眠呼吸暂停的特点是反复出现完全上气道阻塞(呼吸暂停)或部分上气道阻塞(呼吸不足),导致氧不饱和和再饱和的反复发作,以及心率、血压和交感神经活动的周期性变化,以及睡眠破坏。已经发现阻塞性睡眠呼吸暂停与道路交通事故风险增加、工作场所生产力降低、二型糖尿病、胰岛素抵抗、高血压、CVD、生活质量降低和死亡风险增加相关。阻塞性睡眠呼吸暂停是2型糖尿病发展的一个公认的风险因素。最近,我们的研究小组表明,二型糖尿病患者发生阻塞性睡眠呼吸暂停的风险也在增加,这表明阻塞性睡眠呼吸暂停和二型糖尿病之间的关系是双向的。我们之前也在横断面研究中证明了二型糖尿病患者的阻塞性睡眠呼吸暂停与氧化应激、亚硝化应激、聚ADP核糖聚合酶激活和内皮功能障碍相关,并且在队列研究中与糖尿病相关的微血管和大血管并发症相关。然而,对1型糖尿病患者阻塞性睡眠呼吸暂停的了解甚少。考虑到与阻塞性睡眠呼吸暂停相关的显著的上述共病,确定患有1型糖尿病的人是否处于阻塞性睡眠呼吸暂停的增加的风险中是重要的。

由于1型糖尿病患者肥胖和胰岛素抵抗的患病率增加以及自主神经病变的高患病率,1型糖尿病患者可能会增加阻塞性睡眠呼吸暂停的风险,这可能会通过影响上气道控制而导致阻塞性睡眠呼吸暂停的发病机制。几项小型横断面研究报告了1型糖尿病患者中阻塞性睡眠呼吸暂停的高患病率(10–46%)。其他研究表明,与对照组相比,1型糖尿病儿童患者的睡眠中断和阻塞性睡眠呼吸暂停的患病率更高,实验性睡眠限制降低了1型糖尿病患者的胰岛素敏感性,睡眠呼吸暂停和睡眠中断与血糖控制较差相关。然而,这些关联的方向还不清楚,因此需要纵向研究。

目的:本研究旨在检测与无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。

方法:我们使用英国初级保健数据库,健康改善网络(THIN),在1995年1月至2018年1月之间进行回顾性队列研究,比较1型糖尿病(暴露)和非1型糖尿病(未暴露)患者之间的睡眠呼吸暂停发病率(年龄、性别、身体质量指数和全科医生匹配)。结果是阻塞性睡眠呼吸暂停的发生率。基线协变量和特征在研究开始时根据索引日期前记录的最新值进行评估。基于完整病例分析,Cox比例风险回归模型用于估计未调整和调整后的风险比。

结果:总共包括34,147名暴露患者和129,500名匹配的未暴露患者。中位随访时间为5.43年(IQR 2.19–10.11),平均身体质量指数为25.82 kg/m2(标准差4.33)。1型糖尿病患者与非1型糖尿病患者相比,发生阻塞性睡眠呼吸暂停的校正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包括高龄、男性、肥胖、服用抗高血压或降脂药物、房颤和抑郁。

表1阻塞性睡眠呼吸暂停事件HR的Cox比例风险模型(全病例分析)

图1森林图显示了在根据年龄、性别、身体质量指数、Townsend评分和共病情况分层的亚组中,1型糖尿病患者与非糖尿病患者的阻塞性睡眠呼吸暂停的校正HR。HR根据年龄、性别、身体质量指数分类、Townsend五分位数、吸烟状况和酒精摄入量进行了调整

表2 1型糖尿病患者发生阻塞性睡眠呼吸暂停的预测因素(多重插补分析)

结论:与没有糖尿病的人相比,1型糖尿病患者阻塞性睡眠呼吸暂停的风险增加。如果1型糖尿病患者年龄较大、肥胖、为男性、患有房颤或抑郁症,或者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。

原文出处:Alshehri Z,  Subramanian A,  Adderley NJ, et al.Risk of incident obstructive sleep apnoea in patients with type 1 diabetes: a population-based retrospective cohort study.Diabetologia 2022 May 24

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    2022-06-23 tomyang96
  6. [GetPortalCommentsPageByObjectIdResponse(id=1761939, encodeId=96051e61939cd, content=<a href='/topic/show?id=9bea33520d' target=_blank style='color:#2F92EE;'>#BET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3352, encryptionId=9bea33520d, topicName=BET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=docwu2019, createdTime=Sat Oct 08 11:14:27 CST 2022, time=2022-10-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1640165, encodeId=634a16401653a, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Mon Jan 09 13:14:27 CST 2023, time=2023-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1968341, encodeId=214d196834149, content=<a href='/topic/show?id=a4b96e542' target=_blank style='color:#2F92EE;'>#1型糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=675, encryptionId=a4b96e542, topicName=1型糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0e3195, createdName=millore, createdTime=Thu Mar 30 04:14:27 CST 2023, time=2023-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1989197, encodeId=e288198919efd, content=<a href='/topic/show?id=246ee29858f' target=_blank style='color:#2F92EE;'>#睡眠呼吸#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72985, encryptionId=246ee29858f, topicName=睡眠呼吸)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3138208, createdName=zhanfl, createdTime=Fri Apr 14 10:14:27 CST 2023, time=2023-04-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1697012, encodeId=7298169e012cc, content=<a href='/topic/show?id=d2e99e651e4' target=_blank style='color:#2F92EE;'>#阻塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97651, encryptionId=d2e99e651e4, topicName=阻塞)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a23129903429, createdName=tomyang96, createdTime=Thu Jun 23 05:14:27 CST 2022, time=2022-06-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1225313, encodeId=e3951225313d9, content=学到了, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=157d5173023, createdName=146de973m94暂无昵称, createdTime=Wed Jun 08 23:33:26 CST 2022, time=2022-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1225180, encodeId=d28d1225180f9, content=优秀, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0ad54795983, createdName=143889b2m19暂无昵称, createdTime=Wed Jun 08 12:39:55 CST 2022, time=2022-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1475281, encodeId=68f014e5281ed, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Tue Jun 07 13:14:27 CST 2022, time=2022-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1596636, encodeId=c43615966369c, content=<a href='/topic/show?id=70e4396491a' target=_blank style='color:#2F92EE;'>#呼吸暂停#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39649, encryptionId=70e4396491a, topicName=呼吸暂停)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e2a518392360, createdName=119337463, createdTime=Tue Jun 07 13:14:27 CST 2022, time=2022-06-07, status=1, ipAttribution=)]
    2022-06-08 146de973m94暂无昵称

    学到了

    0

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    2022-06-08 143889b2m19暂无昵称

    优秀

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