| Backgroud:Type 2 diabetes and sleep apnea are both common chronic systemic diseases in clinical practice,with the same pathogenesis such as oxidative stress,systemic inflammation,and endothelial dysfunction,which together promote the development of atherosclerosis.Previous studies have shown that coronary artery disease is closely related to type 2 diabetes or sleep apnea,but the relationship and correlation between the comorbidity of the two and coronary artery disease is rare in domestic and foreign reports.Investigations show that the incidence of sleep apnea in type 2 diabetes patients is 50%-70%,and compared with type 2 diabetes patients without sleep apnea,patients with type 2 diabetes who develop sleep apnea after diagnosis have a 55%higher risk of developing cardiovascular disease.However,in our clinical work,few people pay attention to the high-risk population of future cardiovascular adverse events in type 2 diabetes combined with obstructive sleep apnea.Objective:The aim of this study is to explore the clinical general data,obesity-related indicators,sleep respiratory monitoring parameters,and coronary artery disease characteristics of type 2 diabetes patients with obstructive sleep apnea.Furthermore,we will analyze the correlation between the coronary artery disease characteristics of type 2 diabetes patients with obstructive sleep apnea and the relevant clinical indicators,in order to improve understanding and provide clinical evidence for the early prevention and treatment intervention of coronary artery disease in type 2 diabetes patients with obstructive sleep apnea.Methods:Thirty-four patients with type 2 diabetes diagnosed with OSA and coronary angiography were admitted to Dalian Medical University Affiliated First Hospital from December 2018 to October 2022（T2DM&OSA group）,and 39 patients with simple type 2 diabetes who received coronary angiography during the same period（T2DM group）were retrospectively collected.General information,clinical data,sleep respiratory monitoring results,coronary angiography results of all enrolled patients were recorded,body mass index（BMI）,visceral obesity index（VAI）,lipid accumulation product（LAP）,Ty G index,Tyg-BMI,apolipoprotein B/Apolipoprotein A,coronary Gensini score and other indicators were calculated.Statistical analysis was performed.The clinical characteristics of general clinical data,obesity-related indicators and sleep breathing monitoring parameters in type 2diabetes patients with sleep apnea group were analyzed,as well as the differences in the severity of coronary artery lesions between the two groups,and the correlation between coronary artery lesions and related indicators in T2DM&OSA group was discussed.According to AHI results of sleep breathing monitoring test,T2DM&OSA group was divided into 2 groups,mild to moderate group（5-30 times/hour）and severe group（>30 times/hour）,and the differences of various clinical indicators（obesity-related indicators,sleep breathing monitoring parameters,etc.）and the degree of coronary artery lesions between the two groups were analyzed.The relationship between the severity of sleep apnea and the severity of coronary artery disease was also studied.Results:1.VAI（P=0.038）and Ty G（P=0.04）in T2DM&OSA group were higher than those in simple T2DM group（P<0.05）.The levels of BMI（P=0.003）,waist circumference（P<0.001）,LAP（P<0.001）and Ty G-BMI（P<0.001）in T2DM group were significantly higher than those in T2DM group（P<0.01）.There were statistically significant differences in UA（P=0.04）and TG（P=0.01）between T2DM&OSA group and simple T2DM group（P<0.05）,and LAa O2（P<0.001）was statistically significant（P<0.01）.2.Compared with simple T2DM group,patients in T2DM&OSA group had more lesions on the left main trunk,anterior descending rami,left circumflex and right coronary,but the difference was not statistically significant（P>0.05）,but Gensini score（P=0.005）was statistically significant between the two groups（P<0.01）.The Gensini score of T2DM and OSA group was higher.The number of coronary artery lesions in T2DM&OSA group was higher than that in simple T2DM group（P=0.009）,and the difference was statistically significant（P<0.05）.Spearman correlation analysis found that AHI grade in T2DM&OSA group and T2DM group was positively correlated with coronary Gensini score and coronary lesion number（rs=0.386,P=0.001;rs=0.308,P=0.008）.3.Binary Logistic results showed that increased LAP（OR=1.061,P=0.007）was an independent risk factor for OSA in T2DM patients,and glycocated hemoglobin（OR=3.132,P=0.035）was an independent risk factor for severe coronary artery disease in T2DM&OSA patients.4.ROC curve analysis showed that LAP predicted the area under the curve of OSA complications in T2DM patients was 0.770（95%CI:0.624-0.877,P<0.001）,LAP 61.3 had the highest predictive efficiency,and the sensitivity and specificity were 61.8%and 82.1%,respectively,with statistical significance（P<0.05）.Conclusion:1.T2DM&OSA group had higher BMI,waist circumference,body fat index（LAP,VAI,Ty G index and Ty G-BMI）,higher proportion of obesity,higher blood uric acid and triglyceride levels,and lower LSa O2.2.T2DM&OSA group had more multi-vessel coronary artery lesions and more severe coronary artery lesions,and Gensini score and coronary artery lesion counts increased with the increase of OSA severity.Hypoxia was closely related to the severity of coronary artery lesions in patients with type2 diabetes,but there was no difference in the site of coronary artery lesions compared with those without OSA.3.In T2DM patients,LAP is correlated with OSA,and is an independent risk factor for OSA in T2DM patients.A value of LAP>61.3 indicates that OSA may be complicated.However,in T2DM&OSA patients,HBA1c has a greater impact on the severity of coronary lesions than AHI and minimum oxygen saturation,suggesting that T2DM&OSA patients may benefit more from more active blood glucose control in cardiovascular aspects. |
PDF Full Text Request