Glucose profiles in obstructive sleep apnea and type 2 diabetes mellitus
Glucose profiles in obstructive sleep apnea and type 2 diabetes mellitus
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阻塞性睡眠呼吸暂停和 2 型糖尿病的血糖曲线
DOI：
10.1016/j.sleep.2022.04.007
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发表时间：
2022
期刊：
影响因子：
4.8
通讯作者：
Punjabi, Naresh M.
中科院分区：
文献类型：
--
作者：
Aurora, R. Nisha;Gaynanova, Irina;Patel, Pratik;Punjabi, Naresh M.
目的：连续血糖监测（CGM）提供血糖变异性的时间数据，预测2型糖尿病相关结局。目前的研究旨在确定2型糖尿病患者的cgm衍生指标在中度至重度阻塞性睡眠呼吸暂停（OSA）和轻度阻塞性睡眠呼吸暂停（OSA）中是否存在差异。方法对成人2型糖尿病患者进行OSA检测。在氧去饱和指数(ODI)≥5次/小时的患者中，收集至少7天的CGM数据。研究样本分为轻度OSA （ODI: 5.0-14.9事件/小时）和中重度OSA （ODI≥15事件/小时）。活动描记术用于区分清醒期和睡眠期。采用多变量回归模型比较两组间cgm衍生指标。结果与轻度OSA相比，中重度OSA患者在睡眠（调整差8.4 mg/dL， p值为0.03）和清醒（调整差7.1 mg/dL， p值为0.06）时的平均血糖水平较高。与轻度OSA患者相比，中重度OSA患者清醒时血糖值在可接受范围内的几率更低（校正优势比为0.63，p值为0.02）。中度至重度OSA患者血糖偏移的平均幅度和血糖值变化率的标准差（SD-ROC）高于轻度OSA患者，但仅在清醒状态下。性别改变了OSA严重程度与SD-ROC之间的关系，但没有改变其他cgm衍生指标。结论在2型糖尿病患者中，中度至重度OSA与cgm衍生指标的异常相关程度高于轻度OSA，且睡眠和清醒状态差异显著。
ObjectivesContinuous glucose monitoring (CGM) provides temporal data on glycemic variability, a predictor of outcomes related to type 2 diabetes mellitus. The current study sought to determine whether CGM-derived metrics in patients with type 2 diabetes are different in moderate-to-severe versus mild obstructive sleep apnea (OSA).MethodsIn adults with type 2 diabetes, home testing was used of assess the presence of OSA. CGM data were collected for at least 7 days in those with an oxygen desaturation index (ODI) ≥ 5 events/hr. The study sample was divided into mild (ODI: 5.0–14.9 events/hr) and moderate-to-severe OSA (ODI ≥15 events/hr). Actigraphy was used to distinguish the wake and sleep periods. CGM-derived metrics were compared between the two groups using multivariable regression models.ResultsCompared to mild OSA, patients with moderate-to-severe OSA had higher mean glucose levels during sleep (adjusted difference 8.4 mg/dL; p-value: 0.03) and wakefulness (adjusted difference 7.1 mg/dL; p-value: 0.06). Moderate-to-severe OSA patients also had lower odds for having their glucose values within the acceptable range during wakefulness than those with mild OSA (adjusted odds ratio of 0.63; p-value: 0.02). The mean amplitude of glycemic excursion and standard deviation of the rate of change in glucose values (SD-ROC) were higher in moderate-to-severe than mild OSA, but only during wakefulness. Sex modified the association between OSA severity and SD-ROC, but not the other CGM-derived metrics.ConclusionsIn patients with type 2 diabetes, moderate-to-severe OSA is associated with greater abnormalities in CGM-derived metrics than mild OSA with notable differences between sleep and wakefulness.