Diabetes Mellitus Prevalence and Control in Sleep-Disordered Breathing

医学 内科学 糖尿病 阻塞性睡眠呼吸暂停 2型糖尿病 血糖性 人口 队列 2型糖尿病 睡眠呼吸暂停 内分泌学 胰岛素 环境卫生
作者
Brian D. Kent,Ludger Grote,Silke Ryan,Jean‐Louis Pépin,Maria R. Bonsignore,Ružena Tkáčová,Tarja Saaresranta,Johan Verbraecken,Patrick Lévy,Jan Hedner,Walter T. McNicholas
出处
期刊:Chest [Elsevier BV]
卷期号:146 (4): 982-990 被引量:208
标识
DOI:10.1378/chest.13-2403
摘要

BACKGROUND

OSA is associated with an increased risk of cardiovascular morbidity. A driver of this is metabolic dysfunction and in particular type 2 diabetes mellitus (T2DM). Prior studies identifying a link between OSA and T2DM have excluded subjects with undiagnosed T2DM, and there is a lack of population-level data on the interaction between OSA and glycemic control among patients with diabetes. We assessed the relationship between OSA severity and T2DM prevalence and control in a large multinational population.

METHODS

We performed a cross-sectional analysis of 6,616 participants in the European Sleep Apnea Cohort (ESADA) study, using multivariate regression analysis to assess T2DM prevalence according to OSA severity, as measured by the oxyhemoglobin desaturation index. Patients with diabetes were identified by previous history and medication prescription, and by screening for undiagnosed diabetes with glycosylated hemoglobin (HbA1c) measurement. The relationship of OSA severity with glycemic control was assessed in diabetic subjects.

RESULTS

T2DM prevalence increased with OSA severity, from 6.6% in subjects without OSA to 28.9% in those with severe OSA. Despite adjustment for obesity and other confounding factors, in comparison with subjects free of OSA, patients with mild, moderate, or severe disease had an OR (95% CI) of 1.33 (1.04-1.72), 1.73 (1.33-2.25), and 1.87 (1.45-2.42) (P < .001), respectively, for prevalent T2DM. Diabetic subjects with more severe OSA had worse glycemic control, with adjusted mean HbA1c levels 0.72% higher in patients with severe OSA than in those without sleep-disordered breathing (analysis of covariance, P < .001).

CONCLUSIONS

Increasing OSA severity is associated with increased likelihood of concomitant T2DM and worse diabetic control in patients with T2DM.
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