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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (2): 252-255. doi: 10.19723/j.issn.1671-167X.2019.02.009

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Association of sleep overlap syndrome with type 2 diabetes in a cross-sectional study

Jiang XIE(),Fei LI   

  1. Department of Respiratory and Critical Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing 100023, China
  • Received:2017-07-06 Online:2019-04-18 Published:2019-04-26
  • Contact: Jiang XIE E-mail:Frank782008@aliyun.com

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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

CLC Number: 

  • R563

Table 1

Clinical characteristics of 1 939 study subjects"

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

Table 2

Association of sleep overlap syndrome with type 2 diabetes (n=1 939)"

Comparison between groups Unadjusted Adjusted*
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

Table 3

Comparison of type 2 diabetes odds in patients with and without sleep overlap syndrome (n=1 939)"

Items Unadjusted Adjusted*
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
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