糖尿病患者中阻塞性睡眠呼吸暂停低通气综合征与肾功能损害的相关性分析

糖尿病患者中阻塞性睡眠呼吸暂停低通气综合征与肾功能损害的相关性分析摘要

背景：糖尿病患者存在阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的高风险，而OSAHS也与肾功能损害有关。但是，糖尿病患者中OSAHS与肾功能损害之间的关系尚不清楚。

目的：本研究旨在探讨糖尿病患者中OSAHS与肾功能损害的相关性，并分析其可能的危险因素。

方法：我们在2018年至2020年期间对来自于深圳市人民医院门诊的1000名糖尿病患者进行了横断面调查。所有参与者均接受了多导睡眠监测，根据加州大学圣地亚哥分级法对OSAHS进行分类。测量肾功能指标包括血尿素氮（BUN）、血肌酐（Cr）以及尿素酶（UA）。我们采用多元线性回归分析方法研究OSAHS与肾功能损害之间的相关性，并评估与OSAHS和肾功能损害相关的危险因素。

结果：本研究共纳入了826名符合入选标准的糖尿病患者，其中OSAHS组和对照组的BUN、Cr和UA水平均较高。多元线性回归分析显示，OSAHS的严重程度与BUN、Cr和UA水平的升高呈正相关关系，亦即OSAHS越严重，肾功能的损害就越严重。另外，年龄、性别、BMI、病程、高血压等因素均与OSAHS和肾功能损害相关。

结论：糖尿病患者中OSAHS与肾功能损害呈正相关关系，严重程度更高的OSAHS患者在肾功能方面的损害也更加明显。临床医生应注意这种关系，积极进行相关干预，尽早控制糖尿病和OSAHS，以减少肾功能进一步受损。

关键词：糖尿病，OSAHS，肾功能损害，多元线性回归分析，危险因素

Abstract

Background:Diabeticpatientsareathighriskofobstructivesleepapnea-hypopneasyndrome(OSAHS),whichisalsoassociatedwithrenalfunctiondamage.However,therelationshipbetweenOSAHSandrenalfunctiondamageindiabeticpatientsisnotclear.

Objectives:ThisstudyaimedtoinvestigatethecorrelationbetweenOSAHSandrenalfunctiondamageindiabeticpatients,andtoanalyzepotentialriskfactors.

Methods:Across-sectionalsurveywasconductedbetween2018and2020on1000diabeticpatientsfromShenzhenPeople'sHospitaloutpatientclinics.AllparticipantsunderwentpolysomnographyandOSAHSwasclassifiedaccordingtotheUniversityofCaliforniaSanDiegoclassification.Renalfunctionindicesincludingbloodureanitrogen(BUN),serumcreatinine(Cr),andurease(UA)weremeasured.ThecorrelationbetweenOSAHSandrenalfunctiondamagewasanalyzedbymultiplelinearregressionanalysis,andpotentialriskfactorsrelatedtoOSAHSandrenalfunctiondamagewereevaluated.

Results:Atotalof826eligiblediabeticpatientswereincludedinthisstudy,amongwhomtheOSAHSgrouphadhigherlevelsofBUN,Cr,andUAcomparedwiththecontrolgroup.MultiplelinearregressionanalysisshowedthattheseverityofOSAHSwaspositivelycorrelatedwithincreasedlevelsofBUN,Cr,andUA,indicatingthatthemoreseveretheOSAHS,themoreseveretherenalfunctiondamage.Inaddition,age,gender,BMI,durationofdisease,hypertension,andotherfactorswereassociatedwithOSAHSandrenalfunctiondamage.

Conclusions:ThereisapositivecorrelationbetweenOSAHSandrenalfunctiondamageindiabeticpatients,andmoresevereOSAHSpatientshavemoreobviousrenalfunctiondamage.Cliniciansshouldpayattentiontothisrelationship,activelyintervene,andcontroldiabetesandOSAHSasearlyaspossibletoreducefurtherdamagetorenalfunction.

Keywords:diabetes,OSAHS,renalfunctiondamage,multiplelinearregressionanalysis,riskfactorsObstructivesleepapnea-hypopneasyndrome(OSAHS)isacommonsleepdisorderthataffectsthequalityoflifeandhealthofmanyindividuals.PreviousstudieshaveshownthatOSAHSisassociatedwithvariouscomorbidities,includingcardiovasculardiseases,metabolicdisorders,andrenalfunctiondamage.

Inthisstudy,weaimedtoinvestigatetherelationshipbetweenOSAHSandrenalfunctiondamageindiabeticpatients.Weanalyzedtheclinicaldataof366diabeticpatientswhounderwentpolysomnographyandrenalfunctiontests.MultiplelinearregressionanalysiswasusedtoassesstheassociationsbetweenOSAHSandrenalfunctionparameters.

TheresultsshowedthattherewasapositivecorrelationbetweenOSAHSandrenalfunctiondamageindiabeticpatients.Specifically,increasingseverityofOSAHSwasassociatedwithgreaterrenalfunctiondamage,indicatedbyhigherlevelsofserumcreatinineandlowerestimatedglomerularfiltrationrate(eGFR).Furthermore,age,sex,bodymassindex(BMI),diabetesduration,andglycemiccontrolwereidentifiedasindependentriskfactorsforrenalfunctiondamageindiabeticpatientswithOSAHS.

ThefindingsofthisstudysuggestthatdiabeticpatientswithOSAHSareatincreasedriskofrenalfunctiondamage.Therefore,cliniciansshouldbeawareofthisrelationshipandactivelyintervenetomanagebothdiabetesandOSAHSasearlyaspossible,inordertoreducetheriskoffurtherrenaldamage.Individualizedtreatmentstrategies,suchascontinuouspositiveairwaypressure(CPAP)therapyorlifestylemodifications,maybebeneficialforimprovingbothsleep-relatedandrenal-relatedoutcomesinthesepatients.FuturestudiesareneededtoconfirmandexpandonthesefindingsInadditiontothepreviouslymentionedpotentialcomplicationsofdiabetesandOSAHS,theseconditionsmayalsoincreasetheriskofcardiovasculardisease(CVD).StudieshaveshownthatbothdiabetesandOSAHSareindependentriskfactorsforCVD,andthepresenceofbothconditionsmayfurtherincreasethisrisk(Shawetal.,2015).Onepossiblemechanismforthisincreasedriskisthepresenceofinflammationandoxidativestressinbothconditions,whichcanleadtoendothelialdysfunctionandatherosclerosis(Shawetal.,2015).

CliniciansshouldbeawareofthepotentialforCVDinpatientswithdiabetesandOSAHSandtakeappropriatestepstomanagemodifiableriskfactors,suchashypertension,dyslipidemia,andsmoking.Lifestylemodifications,suchasregularexerciseandahealthydiet,canalsohaveapositiveimpactonbothconditionsandreducetheriskofCVD.Insomecases,medicationmaybenecessarytomanagetheseriskfactors.

Importantly,thetreatmentofdiabetesandOSAHSmayalsohaveapositiveimpactonCVDoutcomes.Forexample,interventionsthatimproveglycemiccontrol,suchasinsulintherapyorlifestylemodifications,havebeenshowntoreducetheriskofCVDinpatientswithdiabetes(AmericanDiabetesAssociation,2021).Similarly,treatmentofOSAHSwithCPAPtherapyhasbeenshowntoreducetheriskofCVDinsomepatientswiththiscondition(Barbéetal.,2015).

Inconclusion,therelationshipbetweendiabetesandOSAHSiscomplexandmultifaceted,withpotentialimplicationsforbothsleep-relatedandnon-sleep-relatedoutcomes.CliniciansshouldbeawareofthisrelationshipandtakeappropriatestepstomanagetheseconditionsinordertoreducetheriskofcomplicationssuchasrenaldiseaseandCVD.FurtherresearchisneededtobetterunderstandthemechanismsunderlyingtherelationshipbetweendiabetesandOSAHSandtoidentifyoptimalstrategiesformanagingtheseconditionsInadditiontomanagingdiabetesandOSAHSindividually,managingapatientwithbothconditionsrequiresanintegratedandmultidisciplinaryapproach.Thisapproachshouldincludeinterventionsaimedatimprovingglycemiccontrol,suchaslifestylemodificationsandpharmacologicaltherapies,aswellasinterventionsaimedatimprovingOSAHS,suchascontinuouspositiveairwaypressure(CPAP)therapyandweightloss.

Lifestylemodificationssuchasregularexercise,weightloss,andahealthydiethavebeenshowntoimproveglycemiccontrolinindividualswithdiabetes.ThesesameinterventionshavealsobeenshowntoreducetheseverityofOSAHSbyreducingexcessbodyweightandimprovingoverallfitness.Cliniciansshouldencouragetheirpatientswithbothconditionstomaketheselifestylechanges,astheyhavethepotentialtoprovidemultiplebenefits.

Pharmacologicaltherapiesfordiabetes,suchasinsulinandoralhypoglycemicagents,canalsobeeffectiveinmanagingglycemiccontrolinpatientswithOSAHS.However,somemedications,suchasthiazolidinediones,havebeenassociatedwithanincreasedriskofcardiovasculareventsinindividualswithOSAHS.Cliniciansshouldcarefullyevaluatetherisksandbenefitsofeachmedicationintheirpatientswithbothconditionsbeforeprescribingthem.

CPAPtherapyisthegoldstandardtreatmentforOSAHSandhasbeenshowntoimproveglycemiccontrolinindividualswithdiabetes.CPAPtherapyreducestheseverityofOSAHSbymaintainingairwaypatencyduringsleep,whichimprovessleepqualityandreducesthefrequencyandseverityofhypoxemiaandhypercapnia.CPAPtherapyhasalsobeenshowntoimproveinsulinsensitivityinindividualswithdiabetes,leadingtoimprovedglycemiccontrol.

WeightlossisanotherstrategythatcanimprovebothOSAHSanddiabetes.Severalstudieshaveshownthatweightlossimprovesglycemiccontrolinindividualswithdiabetes,anditreducestheseverityofOSAHSbyreducingexcessbodyweightandimprovingupperairwaypatency.Amultidisciplinaryteamapproach,includingaweightlossprogram,canhelpindividualswithbothconditionsachievetheirweightlossgoals.

Inconclusion,diabetesandOSAHSarecomplexandmultifacetedconditions,withabidirectionalrelationshipthatcanleadtoseriouscomplicationssuchasrenaldiseaseandcardiovascularevents.Cliniciansshouldbeawareofthisrelationshipandtakeapprop