Association Between Obstructive Sleep Apnea Hypopnea Syndrome And Renal Function Damage In Patients With Diabetes Mellitus

PurposeDiabetes can damage endothelial cells and lead to microangiopathy through disorders of glucose metabolism,insulin resistance and other reasons.Obstructive sleep apnea hypopnea syndrome（OSAHS）can damage endothelial cells and lead to microvascular lesions due to oxidative stress and promoting the release of inflammatory cytokines.Whether OSAHS complicated with diabetes will aggravate the damage of renal function,however,there are few related studies at present.Therefore,the purpose of this study is to explore the effect of OSAHS on renal function damage in people with diabetes.MethodsAll patients diagnosed with diabetes who went to the Sleep Disorder diagnosis and treatment Center of our hospital due to sleep problems were collected from October 2018 to December 2020.The data of polysomnography were recorded,height,weight and other physical examination parameters were measured.Fasting venous blood was collected from the next morning to detect fasting blood glucose,serum creatinine,uric acid and other serological indexes.Estimated glomerular filtration rate（eGFR）was estimated by CKD-EPI formula and Chinese modified MDRD formula.According to the value of apnea hypopnea index（AHI）,AHI<5 times/h was divided into control group,5≤AHI<30 times/h was divided into mild to moderate OSAHS group,and AHI≥30 times/h was divided into severe OSAHS group.ResultsA total of 256 patients were included in this study,including 184 males and 72females,with an average age of 57.28±13.43 years old（range:19-90 years old,average）,BMI 28.09±4.37kg/m²ï¼ˆrange:18.70-47.00kg/m²ï¼‰.The OSAHS group included mild to moderate OSAHS group（123 cases）,severe OSAHS group（109cases）and control group（24 cases）.There was no significant difference in antihypertensive therapy,smoking,course of diabetes,MAP,TC,TG,HDL-C,LDL-C,and fasting plasma glucose among groups.There were significant differences in age,sex ratio,hypoglycemic therapy,lipid lowering therapy,BMI,neck circumference,waist circumference,AHI,ODI,T90%,LaSO₂,average SpO₂,ESS,uric acid,creatinine,eGFR-EPI and eGFR-MDRD among the groups.With the increase of the severity of OSAHS,serum creatinine increased from 54.76umol/l to 74.76umol/l,and decreased from 132.17 ml/min to 101.10 ml/min and eGFR-EPI from 110.22ml/min to 96.52 ml/min.Spearman correlation analysis showed that AHI,ODI and T90%of sleep parameters were significantly negatively correlated with eGFR（calculated by CKD-EPI formula or Chinese modified MDRD formula）,while average SpO₂and La SO₂were positively correlated with them.Stepwise linear regression with eGFR-EPI as a dependent variable（R²=0.208）:fasting blood glucose（β=0.244,P=0.000）,course of diabetes（β=ï¹£0.271,P=0.000）,AHI（β=ï¹£0.162,P=0.022）and La SO₂（β=0.218,P=0.002）.Stepwise linear regression with eGFR-MDRD as a dependent variable（R²=0.129）:fasting blood glucose（β=0.197,P=0.005）,course of diabetes（β=-0.181,P=0.010）,AHI（β=-0.170,P=0.022）and LaSO₂（β=0.173,P=0.020）.EGFR-EPI regression model reveals the similar results of eGFR-MDRD regression model,that is,AHI and La SO₂are independent risk factors for the decrease of eGFR.ConclusionOSAHS is an independent risk factor for renal damage in patients with diabetes.