Distinct impacts of sleep-disordered breathing on glycemic variability in patients with and without diabetes mellitus

BackgroundSleep-disordered breathing (SDB) is highly prevalent in patients with diabetes mellitus (DM) and heart failure (HF) and contributes to poor cardiovascular outcomes. Enlarged glycemic variability (GV) is a risk factor of cardiac events independently of average blood glucose level, but the influence of SDB on GV is uncertain. In this study, we examined whether the impact of SDB on GV is modified by the presence of DM with or without HF.Methods and resultsTwo hundred three patients (67.5±14.1 [SD] years old, 132 males) who were admitted to our institute for examination or treatment of DM and/or HF underwent continuous glucose monitoring and polysomnography. Both HbA1c (8.0±2.0 vs. 5.7±0.4%) and mean amplitude of glycemic excursion (MAGE, median: 95.5 vs. 63.5 mg/dl) were significantly higher in a DM group (n = 100) than in a non-DM group (n = 103), but apnea-hypopnea index (AHI: 29.0±22.7 vs. 29.3±21.5) was similar in the two groups. AHI was correlated with log MAGE in the non-DM group but not in the DM group, and multivariate regression analysis revealed that AHI was an independent variable for log MAGE in the non-DM group but not in the DM group. We then divided the non-DM patients into two subgroups according to BNP level (100 pg/ml). AHI was positively correlated with log MAGE (r = 0.74, pConclusionSeverity of SDB was associated with higher GV, but DM as well as HF diminished the contribution of SDB to GV. Treatment with CPAP was effective for reduction of GV only in patients without DM.背景：睡眠呼吸障碍（Sleep-disordered breathing, SDB）在糖尿病（diabetes mellitus, DM）与心力衰竭（heart failure, HF）患者中患病率极高，且会增加不良心血管事件的发生风险。血糖变异性（glycemic variability, GV）增大是独立于平均血糖水平的心脏事件危险因素，但睡眠呼吸障碍对血糖变异性的影响尚不明确。本研究旨在探讨合并或不合并心力衰竭的糖尿病是否会调节睡眠呼吸障碍对血糖变异性的影响。 方法与结果：本研究纳入203例因糖尿病和/或心力衰竭就诊于我院接受检查或治疗的患者，年龄为67.5±14.1岁（标准差，SD），其中男性132例。所有受试者均接受了动态血糖监测（continuous glucose monitoring）与多导睡眠图（polysomnography）检查。糖尿病组（n=100）的糖化血红蛋白（HbA1c，8.0±2.0% vs 5.7±0.4%）与平均血糖波动幅度（mean amplitude of glycemic excursion, MAGE，中位数：95.5 vs 63.5 mg/dl）均显著高于非糖尿病组（n=103），但两组的呼吸暂停低通气指数（apnea-hypopnea index, AHI：29.0±22.7 vs 29.3±21.5）无显著差异。在非糖尿病组中，呼吸暂停低通气指数与对数转换后的平均血糖波动幅度呈正相关，而糖尿病组则无此关联；多因素回归分析显示，在非糖尿病组中呼吸暂停低通气指数是对数转换后平均血糖波动幅度的独立影响因素，但在糖尿病组中并非如此。随后，研究人员根据脑钠肽（BNP）水平（100 pg/ml）将非糖尿病患者分为两个亚组，结果显示呼吸暂停低通气指数与对数转换后的平均血糖波动幅度呈显著正相关（r = 0.74, p。 结论：睡眠呼吸障碍的严重程度与更高的血糖变异性相关，但糖尿病与心力衰竭均会削弱睡眠呼吸障碍对血糖变异性的影响。仅在无糖尿病的患者中，持续气道正压通气（CPAP）治疗可有效降低血糖变异性。