Table_2_Shorter respiratory event duration is related to prevalence of type 2 diabetes.docx

BackgroundObstructive sleep apnea (OSA) is a heterogeneous sleep disorder often comorbid with metabolic diseases, and type 2 diabetes (T2DM) is one of them. Although apnea hypopnea index (AHI) is currently the diagnostic criteria for OSA severity, a controversial relationship between AHI and T2DM has been found. On the other hand, the duration of apnea–hypopnea events has been shown to be a useful metric for predicting mortality. This study aimed to test whether average respiratory event duration was associated with prevalence of T2DM.
MethodsPatients referred to the sleep clinic were recruited in the study. Baseline clinical characteristics and polysomnography parameters including average respiratory event duration were collected. The association of average respiratory event duration with the prevalence of T2DM was evaluated by univariate and multivariate logistic regression analyses.
ResultsA total of 260 participants were enrolled, and 92 (35.4%) had T2DM. Univariate analysis revealed that age, body mass index (BMI), total sleep time, sleep efficiency, history of hypertension, and shorter average respiratory event duration were associated with T2DM. In multivariate analysis, only age and BMI remained significant. While average respiratory event duration was insignificant in multivariate analysis, subtype event analysis showed that shorter average apnea duration was both significant in univariate (OR, 0.95; 95% CI, 0.92–0.98) and multivariate analyses (OR, 0.95; 95% CI, 0.91–0.99). Neither average hypopnea duration nor AHI was associated with T2DM. Significant association (OR, 1.19; 95% CI, 1.12–1.25) was observed between shorter average apnea duration and lower respiratory arousal threshold after multivariate adjustment. However, causal mediation analysis revealed no mediating effect of arousal threshold on average apnea duration and T2DM.
ConclusionThe average apnea duration may be a useful metric in the diagnosis of OSA comorbidity. Shorter average apnea duration indicating poor sleep quality and augmented autonomic nervous system responses might be the potential pathological mechanisms leading to T2DM.

研究背景：阻塞性睡眠呼吸暂停（Obstructive Sleep Apnea, OSA）是一类异质性睡眠障碍，常与代谢性疾病共病，其中2型糖尿病（Type 2 Diabetes Mellitus, T2DM）是其常见共病之一。目前临床以呼吸暂停低通气指数（Apnea Hypopnea Index, AHI）作为阻塞性睡眠呼吸暂停病情严重程度的诊断标准，但已有研究显示AHI与T2DM之间的关联存在争议。另一方面，呼吸暂停低通气事件的时长已被证实是预测死亡风险的有效指标。本研究旨在探讨平均呼吸事件时长（average respiratory event duration）与T2DM患病率之间的关联。
研究方法：本研究纳入转诊至睡眠门诊的受试者，收集其基线临床特征及多导睡眠图参数，包括平均呼吸事件时长。采用单变量及多变量logistic回归分析，评估平均呼吸事件时长与T2DM患病率的关联。
研究结果：本研究共纳入260名受试者，其中92例（35.4%）合并T2DM。单变量分析显示，年龄、体重指数（Body Mass Index, BMI）、总睡眠时间、睡眠效率、高血压病史以及更短的平均呼吸事件时长与T2DM显著相关。多变量分析中，仅年龄与BMI仍具有统计学意义。尽管平均呼吸事件时长在多变量分析中无统计学显著性，但亚型事件分析结果显示，更短的平均呼吸暂停时长（average apnea duration）在单变量分析（比值比OR=0.95，95%置信区间CI：0.92~0.98）与多变量分析（OR=0.95，95%CI：0.91~0.99）中均表现出显著关联。平均低通气时长（average hypopnea duration）与AHI均与T2DM无显著关联。经多变量校正后，更短的平均呼吸暂停时长与更低的呼吸唤醒阈值（respiratory arousal threshold）之间存在显著关联（OR=1.19，95%CI：1.12~1.25）。然而，因果中介分析（causal mediation analysis）显示，呼吸唤醒阈值在平均呼吸暂停时长与T2DM的关联中未起到中介作用。
研究结论：平均呼吸暂停时长或可作为阻塞性睡眠呼吸暂停共病的辅助评估指标。提示睡眠质量不佳与自主神经系统反应增强的更短平均呼吸暂停时长，可能是导致T2DM发生的潜在病理生理机制。