睡眠重叠综合征与糖尿病发病率的横断面调查研究

doi:10.19723/j.issn.1671-167X.2019.02.009

摘要/Abstract

摘要：

目的: 阻塞性睡眠呼吸暂停(obstructive sleep apnea, OSA)与慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)均增加冠状动脉粥样硬化性心脏病(简称冠心病)和代谢性疾病的风险,但鲜有研究关注二者合并的睡眠重叠综合征是否比单一疾病更为增加临床患病概率,本研究目的是调查睡眠重叠综合征与糖尿病发病率的相关性。方法: 回顾2011年1月至2014年12月在北京安贞医院睡眠医学中心接受便携式睡眠监测的1 939名患者。COPD的诊断基于临床表现和肺功能,OSA的诊断需要呼吸暂停低通气指数 ≥15次/h。研究对象被分为对照组(n=1 093)、单纯COPD组(n=62)、单纯OSA组(n=735)、重叠综合征组(n=49),使用Logistic回归模型分析糖尿病发病的相关因素。结果: 重叠综合征患者患2型糖尿病的概率均高于对照组和单纯OSA患者(OR=5.82, 95%CI:3.23~10.48, P<0.001和OR=4.35, 95%CI:2.41~7.88, P<0.001)。矫正年龄、性别、体重指数等因素后差异仍有统计学意义(OR=2.69, 95%CI:1.13~6.52, P=0.026和OR=3.64, 95%CI:1.53~8.83, P=0.004)。年龄<58岁的患者和女性患者中,重叠综合征与2型糖尿病的发生存在独立相关性(OR=8.45, 95%CI:1.46~65.90, P=0.018与OR=4.39, 95%CI:1.04~22.50, P=0.044);年龄≥58岁的患者和男性患者中,重叠综合征与糖尿病发病无显著相关性。结论: 睡眠重叠综合征与2型糖尿病的发病存在相关性,需要进一步研究证实治疗重叠综合征是否能降低代谢异常的风险,甚至减少未来并发症的概率。

关键词: 睡眠重叠综合征, 2型糖尿病, 慢性阻塞性肺疾病, 阻塞性睡眠呼吸暂停

Abstract:

Objective: Growing evidence indicates that both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) may be related to increased risk of developing metabolic disorder and cardiovascular diseases. However, the association of sleep overlap syndrome (combination of COPD and OSA) with type 2 diabetes is unclear. The aim of this study was to investigate the association between overlap syndrome and prevalence of type 2 diabetes.Methods: In this study, 1 939 patients who completed home sleep test from January 2011 to December 2014 in sleep center of Beijing Anzhen Hospital were retrospectively studied. Sleep events were scored by experienced sleep technicians. COPD were diagnosed according to clinical manifestation and spirometry, while OSA was defined by apnea-hypopnea index ≥15 event/h. All subjects were divided retrospectively into overlap syndrome group (n=1 093), isolated COPD group (n=62), isolated OSA group (n=735), and control group (n=49). The independent association of overlap syndrome with type 2 diabetes prevalence was estimated by using Logistic regression models.Results: Compared with control group and the patients with isolated OSA, the patients with overlap syndrome had significantly higher odds of type 2 diabetes (OR=5.82, 95%CI: 3.23-10.48, P<0.001 and OR=4.35, 95%CI: 2.41-7.88, P<0.001), with significance persisting after adjusting for age, sex, and body mass index as confounding factors (OR=2.69, 95%CI: 1.13-6.52, P=0.026 and OR=3.64, 95%CI: 1.53-8.83, P=0.004). Among those younger than 58 years or female subjects, overlap syndrome had independent association with type 2 diabetes (OR=8.45, 95%CI: 1.46-65.90, P=0.018 and OR=4.39, 95%CI: 1.04-22.50, P=0.044). No significant association was found in the patients ≥58 and male subjects.Conclusion: Sleep overlap syndrome is associated with high prevalence of type 2 diabetes. Further study is needed to verify whether treatment toward overlap syndrome may reduce risk of metabolic disorder, and even decrease long-term risk of complications of diabetes.

Key words: Sleep overlap syndrome, Type 2 diabetes mellitus, Chronic obstructive pulmonary disease, Obstructive sleep apnea

中图分类号:

R563

谢江,李菲. 睡眠重叠综合征与糖尿病发病率的横断面调查研究[J]. 北京大学学报（医学版）, 2019, 51(2): 252-255.

Jiang XIE,Fei LI. Association of sleep overlap syndrome with type 2 diabetes in a cross-sectional study[J]. Journal of Peking University(Health Sciences), 2019, 51(2): 252-255.

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参考文献 13

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Items	Control (n=1 093)	Isolate COPD (n=62)	Isolate OSA (n=735)	Overlap syndrome (n=49)	P value
Age/years	56 (45, 66)	69 (59, 77)	64 (54, 73)	69 (63, 76)	<0.001
Male	531 (48.6)	38 (61.3)	507 (69.0)	31 (63.3)	<0.001
Lowest saturation/%	87 (83, 89)	84 (81, 86)	81 (76, 85)	78 (71, 84)	<0.001
AHI/(event/h)	5 (2, 8)	6 (2, 9)	32 (21, 53)	52 (25, 85)	<0.001
Body mass index/(kg/m²)	25.9 (22.3, 30.6)	28.0 (23.5, 33.2)	28.2 (24.4, 32.3)	29.0 (26.2, 34.6)	<0.001
Diabetes	166 (15.2)	22 (35.5)	142 (19.3)	25 (51.0)	<0.001
Hypertension	394 (36.1)	37 (59.7)	377 (51.3)	35 (71.4)	<0.001
Coronary artery disease	176 (16.1)	32 (51.6)	174 (23.7)	22 (44.9)	<0.001
History of smoking	711 (65.1)	51 (82.3)	462 (62.9)	36 (73.5)	0.011
Cerebrovascular disease	26 (2.4)	1 (1.6)	40 (5.4)	2 (4.1)	0.005
Renal disease	23 (2.1)	2 (3.2)	19 (2.6)	0	0.602
Heart failure	46 (4.2)	8 (12.9)	62 (8.4)	13 (26.5)	<0.001

Comparison between groups	Unadjusted
Comparison between groups	OR	95%CI	P value	OR	95%CI	P value
Isolate OSA vs. Control	1.34	1.04-1.71	0.023	0.74	0.52-1.05	0.093
Isolate COPD vs.Control	3.07	1.75-5.25	<0.001	1.65	0.81-3.27	0.165
Sleep overlap syndrome vs.Control	5.82	3.23-10.48	<0.001	2.69	1.13-6.52	0.026
Sleep overlap syndrome vs. Isolate OSA	4.35	2.41-7.88	<0.001	3.64	1.53-8.83	0.004
Sleep overlap syndrome vs. Isolate COPD	1.89	0.89-4.11	0.100	1.63	0.57-4.75	0.360

Items	Unadjusted
Items	OR	95%CI	P value	OR	95%CI	P value
Age<58 years old (n=893)^*	6.34	1.55-24.40	0.013	8.45	1.46-65.90	0.018
Age≥58 years old (n=1 046)^*	3.71	1.96-7.07	<0.001	2.24	0.86-5.94	0.099
Male (n=1 107)^#	5.70	2.76-11.94	<0.001	2.46	0.85-7.12	0.096
Female (n=832)^#	3.82	1.43-9.85	0.009	4.39	1.04-22.50	0.044