Correlation Study Of Serum Adiponectin And ICAM-1 In Type 2 Diabetes Mellitus Patients With OSA

Background:Obstructive sleep apnea(OSA)and type 2 diabetes mellitus(T2DM)are two diseases that cause and effect each other.Adiponectin is an insulin-sensitizing hormone.The occurrence and development of type 2 diabetes mellitus and OSA are related to the changes of adiponectin levels in the body.Intercellular cell adhesion molecule-1(ICAM-1)is a biomarker of oxidative stress and inflammation.And increased levels of serum ICAM-1 have been found in patients with OSA and type 2 diabetes mellitus.However,the expression levels of serum adiponectin and ICAM-1 in patients with OSA in type 2 diabetes are still unclear.Objective:(1)To analyze the correlation between serum adiponectin,ICAM-1 levels and OSA severity;(2)To analyze the influencing factors of OSA in patients with type 2 diabetes mellitus,and to explore the clinical value of serum adiponectin and ICAM-1 levels in the identification of OSA in patients with type 2 diabetes mellitus;(3)To investigate the correlation between adiponectin and ICAM-1 in type 2 diabetes mellitus patients with OSA.Methods:In this study,patients who were hospitalized in the Department of Respiratory and Critical Care Medicine and Endocrinologyf of the Affiliated Hospital of Yangzhou University from January 1,2021 to December 31,2022 due to nocturnal snoring,apnea,nocturia,daytime sleepiness,fatigue,headache,dry mouth and other symptoms were admitted to the Sleep Medicine Center for polysomnography(PSG).According to OSA and type 2 diabetes mellitus diagnostic criteria,the 169 patients were divided into control group(n=48,they did not meet the diagnostic criteria for OSA and T2DM),T2DM group(n=30),OSA group(n=35)and T2DM with OSA group(n=56).The general data of all the enrolled patients were collected,the elbow venous blood was collected from the patients on the morning of polysomnography monitoring day,and sent to the laboratory center of our hospital to detect glucose and lipid metabolism,and calculate the insulin resistance index(HOMA-IR).The serum adiponectin and ICAM-1 levels were detected by enzyme-linked immunosorbent assay kit.Laboratory blood test results required by the patients were recorded:fasting blood glucose(FPG),fasting C-peptide(FCP),glycated hemoglobin(HbAlc),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),triglyceride(TG),etc.Main polysleep monitoring indicators:Apnea hypopnea index(AHI),mean blood oxygen saturation(MSaO2),minimum blood oxygen saturation(LSaO2).SPSS21.0 was used to analyze the data.Results:1.General data:there were no significant differences in gender,age,smoking history,drinking history,and hypertension history among the control group,T2DM group,OSA group,and T2DM with OSA group(P>0.05).There were significant differences in the history of dyslipidemia among the control group,the T2DM group,the OSA group,and the T2DM and OSA group(P<0.05).The body mass index of the T2DM group,the OSA group and the T2DM and OSA group was higher than that of the control group,and the difference was statistically significant(P<0.05).2.Comparison of serum adiponectin and ICAM-1 in each group:adiponectin level in T2DM,OSA and OSA groups was lower than that in control group(P<0.05),and adiponectin level in T2DM with OSA group was lower than that in T2DM and OSA groups(P<0.05).The level of ICAM-1 in T2DM,OSA and OSA groups was higher than that in control group(P<0.05),and the level of ICAM-1 in T2DM and OSA group was higher than that in T2DM group(P<0.05).3.Correlation analysis of adiponectin,ICAM-1 and OSA severity:(1)Serum adiponectin levels decreased gradually with the increase of OSA severity,adiponectin levels in mild,moderate and severe OSA groups were compared with those in non-OSA groups(AHI<5 times/h)(P<0.001);(2)With the increase of OSA severity,the serum ICAM-1 level was gradually increased,and the level of mild,moderate and severe OSA was compared with that of non-OSA groups(P<0.001).(3)Correlation between serum adiponectin,ICAM-1 and AHI:serum adiponectin was negatively correlated with AHI(r=-0.618,P<0.001),and serum ICAM-1 was positively correlated with AHI(r=0.651,P<0.001).4.Binary Logistic regression analysis and ROC curve of OSA in T2DM patients:(1)Binary Logistic regression showed that high levels of FPG,HOMA-IR,TG and ICAM-1 were risk factors for OSA in T2DM patients,and high levels of HDL-C and adiponectin were protective factors for OSA in T2DM patients.(2)The area under the curve of serum adiponectin level predicted OSA in type 2 diabetes mellitus patients was 0.810,and the best cut-off value was 12.89μg/ml(sensitivity 73.3%,specificity 76.8%).Serum ICAM-1 level predicted the area under the curve of OSA in type 2 diabetes mellitus patients with 0.794,and the optimal cut-off value was 307.26ng/ml(sensitivity 91.1%,specificity 56.7%).S.The correlation between adiponectin,ICAM-1,sleep index and glucose metabolism index in OSA group was as following:adiponectin was negatively correlated with AHI and HOMA-IR(r=-0.313,P=0.019;r=-0.315,P=0.018),was positively correlated with MSaO2(r=0.319,P=0.007);ICAM-1 was positively correlated with AHI and FPG(r=0.389,P=0.003;r=0.346,P=0.009),was negatively correlated with MSaO2(r=-0.435,P=0.001);FPG,HbAlc were positively correlated with AHI(r=0.465,P=0.003;r=0.628,P<0.001);ICAM-1 was negatively correlated with adiponectin(r=-0.736,P<0.001).6.Correlation between adiponectin and ICAM-1 in OSA patients with T2DM:ICAM-1 was negatively correlated with adiponectin(r=-0.736,P<0.001),adiponectin combined with ICAM-1 predicted the area under the curve of type 2 diabetes mellitus patients with OSA by 0.835(sensitivity 60.7%,specificity 96.7%).Conclusions:1.The serum adiponectin level of type 2 diabetes mellitus patients with OSA was lower than that of type 2 diabetes mellitus patients with OSA,and the serum ICAM-1 level of type 2 diabetes mellitus patients with OSA was higher than that of type 2 diabetes mellitus patients with OSA.2.Serum adiponectin and ICAM-1 were correlated with the severity of OSA;serum adiponectin and ICAM-1 are expected to be one of biomarkers for OSA in T2DM patients.3.In T2DM patients with OSA,serum ICAM-1 is negatively correlated with adiponectin.The detection of serum adiponectin and ICAM-1 can improve the identification of OSA patients with T2DM.