≥60岁2型糖尿病患者黎明现象与睡眠障碍的相关性研究

Association between dawn phenomenon and sleep disorders in elderly patients with type 2 diabetes

目的了解≥60岁2型糖尿病(T2DM)患者黎明现象与睡眠障碍的关系.方法396例T2DM患者为2014年1月至2017年1月在复旦大学附属华东医院内分泌科就诊、年龄60~80岁、糖化血红蛋白(HbA1c)水平<8.5%,行72h动态血糖监测(CGMS),口服降糖药物治疗>3个月者.采用匹兹堡睡眠质量指数量表(PSQI)评估睡眠质量,PSQI总分>7分为存在睡眠障碍.396例中,165例发生黎明现象(黎明现象组),231例未发生黎明现象(无黎明现象组).对两组患者的一般资料、血糖相关指标、稳态模型-胰岛素抵抗指数(HOMA-IR)、PSQI总分进行比较,对其与黎明现象的关系行相关性及回归分析.结果两组患者年龄、BMI、血脂、肝肾功能、超敏CRP、血清胱抑素、晨8:00血清皮质醇水平差异均无统计学意义(均P>0.05).黎明现象组尿蛋白/肌酐[1.3(0.7,5.4)和1.1(0.5,3.4)mg/mmol,t=-2.105,P=0.04]、PSQI总分[(7.3±3.3)和(5.4±2.7)分,t=3.587,P<0.01]、睡眠障碍发生率[57.0%(94/165)和25.1%(58/231),x2=3.765,P<0.01]均高于无黎明现象组.黎明现象组的HbA1c[(7.4±0.9)%]和空腹血糖[(8.3±1.6)mmol/L]水平显著高于无黎明现象组[(7.0±1.0)%,t=3.384,P<0.01;(7.0±1.4)mmol/L,t=8.778,P<0.01],而空腹胰岛素[(8.2±7.2)mU/L]和夜间最低血糖[(5.7±1.3)mmol/L]水平低于无黎明现象组[(10.3±10.2)mU/L,t=-2.286,P-0.02;(6.6±1.4)mmol/L,t=-6.331,P<0.01].Pearson相关分析示黎明现象与睡眠障碍呈正相关(r=0.323,P<0.01).logistic回归分析显示黎明现象风险的增加与睡眠障碍相关(OR=4.143,95%CI:1.69~10.16,P<0.01).结论睡眠障碍与≥60岁T2DM患者黎明现象的发生有相关性.

Objective To investigate the association between dawn phenomenon and sleep disorders in elderly patients with type 2 diabetes mellitus (T2DM). Methods Three hundred and ninety-six T2DM patients aged 60-80 years were recruited from Department of Endocrinology, Huadong Hospital from January 2014 to January 2017. All cases used oral hypoglycemic drug more than 3 months, their glycosylated hemoglobin (HbAlc) was lower than 8.5% and underwent continuous glucose monitoring for 72 h. The Pittsburgh sleep quality index (PSQI) scale was applied to evaluate sleep quality, and the PSQI>7 was defined as the sleep disorder. There was dawn phenomenon in 165 cases (group I ) and no dawn phenomenon in 231 cases(group D ). The clinical data, blood glucose related indicators, homeostasis model assessment of insulin resistance (HOMA-IR) and PSQI scores were compared between two groups. The correlation between dawn phenomenon and sleep disorder was analyzed with Logistic regression. Results There were no significant differences in age, BMI, blood lipids, liver and kidney function, hypersensitive CRP(hCRP), serum cystatin and serum cortisol between the two groups (all P>0.05). Patients in group 1 presented a higher ratio of urinary protein/creatinine [ 1.3 (0.7, 5.4) mg/ mmol vs. 1.1 (0.5, 3.4) mg/mmol,￡=-2.105, P=0.04], PSQI scores [(7.3±3.3) qs.(5.4±2.7),i=3.587, PvO.Ol] and the incidence of sleep disorders [ 57.0%(94/165) vs. 25.1%(58/23l),x2=3.765,P<0.01] than those in group U . The HbAlc [(7.4±0.9)%如(7.0± 1.0)%,￡= 3.384, PvO.Ol ] and fasting glucose [(8.3±1.6) mmol/L vs.(7.0± 1.4) mmol/L,/= 8.77& P<0.01] were significantly higher in group 1 than those in group U;while the fasting insulin [(8.2±7.2) mU/L vs.(10.3±10.2) mU/Lj =-2.286,P=0.02] and nocturnal nadir [(5.7± 1.3) mmol/L vs.(6.6± 1.4) mmol/L,￡=-6.331 ,P<0.01 ] were lower than those in group U . Pearson correlation analysis showed that dawn phenomenon was positively correlated with sleep disorders (r=0.323, PvO.Ol). Logistic regression analysis showed that sleep disorders were associated with increased risk of dawn phenomenon (O/?=4.143,95%C/;1.69-10.16, P<0.01). Conclusion Sleep disorders may play a relevant pathological role in the occurrence of dawn phenomenon in elderly T2DM patients.