Association between obstructive sleep apnea severity and endothelial dysfunction in patients with type 2 diabetes.
Association between obstructive sleep apnea severity and endothelial dysfunction in patients with type 2 diabetes.
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DOI：
10.1186/s12933-017-0521-y
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发表时间：
2017-03-21
影响因子：
9.3
通讯作者：
Gagnadoux F
中科院分区：
文献类型：
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作者：
Bironneau V;Goupil F;Ducluzeau PH;Le Vaillant M;Abraham P;Henni S;Dubois S;Paris A;Priou P;Meslier N;Sanguin C;Trzépizur W;Andriantsitohaina R;Martinez MC;Gagnadoux F
阻塞性睡眠呼吸暂停 (OSA) 和 2 型糖尿病 (T2D) 与内皮功能障碍相关，内皮功能障碍是晚期心血管 (CV) 事件的主要预测因素。尽管 OSA 在 T2D 患者中患病率很高，但 OSA 严重程度对内皮功能的影响尚未明确阐明。这项横断面研究的目的是确定 OSA 严重程度的增加是否与 T2D 患者内皮功能较差相关。 140 名没有明显心血管疾病的 T2D 患者接受了多导睡眠图、外周动脉张力测定、临床血压 (BP) 测量、心血管危险因素的生物评估、日间嗜睡和健康相关生活质量 (HRQL) 问卷调查。以下常用的呼吸暂停低通气指数 (AHI) 临界值用于定义 3 类疾病严重程度：AHI < 15（无 OSA 或轻度 OSA）、15 ≤ AHI < 30（中度 OSA）和 AHI ≥ 30（重度 OSA）。主要结果是反应性充血指数（RHI），这是对内皮功能的有效评估。 21.4% 的患者患有中度 OSA，47.6% 的患者患有重度 OSA。 OSA 严重程度的增加和夜间低氧血症与 RHI 的显着下降无关。没有 OSA 或轻度 OSA、中度 OSA 和重度 OSA 的患者中，分别有 47.1%、44.4% 和 39.2% 发现内皮功能障碍 (RHI < 1.67) (p = 0.76)。调整体重指数等混杂因素后，OSA 严重程度的增加与收缩压升高 (p = 0.03)、脂联素循环水平降低 (p = 0.0009)、sP-选择素水平升高 (p = 0.03)、HRQL 3 个领域的得分较低相关，包括能量/活力 (p = 0.02)、角色功能 (p = 0.01) 和社会功能（p = 0.04）。中度至重度 OSA 很常见，但对 T2D 患者的指微血管内皮功能没有影响。
Obstructive sleep apnea (OSA) and type 2 diabetes (T2D) are associated with endothelial dysfunction a main predictor of late cardiovascular (CV) events. Despite the high prevalence of OSA in patients with T2D, the impact of OSA severity on endothelial function has not been clearly elucidated. The aim of this cross-sectional study was to determine whether increasing OSA severity is associated with poorer endothelial function in patients with T2D. 140 patients with T2D and no overt CV disease underwent polysomnography, peripheral arterial tonometry, clinic blood pressure (BP) measurement, biological assessment for CV risk factors, daytime sleepiness and health related quality of life (HRQL) questionnaires. The following commonly used cut-offs for apnea-hypopnea index (AHI) were used to define 3 categories of disease severity: AHI < 15 (no OSA or mild OSA), 15 ≤ AHI < 30 (moderate OSA), and AHI ≥ 30 (severe OSA). The primary outcome was the reactive hyperemia index (RHI), a validated assessment of endothelial function. 21.4% of patients had moderate OSA and 47.6% had severe OSA. Increasing OSA severity and nocturnal hypoxemia were not associated with a significant decrease in RHI. Endothelial dysfunction (RHI < 1.67) was found in 47.1, 44.4 and 39.2% of patients with no OSA or mild OSA, moderate OSA and severe OSA, respectively (p = 0.76). After adjustment for confounders including body mass index, increasing OSA severity was associated with higher systolic BP (p = 0.03), lower circulating levels of adiponectin (p = 0.0009), higher levels of sP-selectin (p = 0.03), lower scores in 3 domains of HRQL including energy/vitality (p = 0.02), role functioning (p = 0.01), and social functioning (p = 0.04). Moderate to severe OSA is very common but has no impact on digital micro-vascular endothelial function in patients with T2D.