阻塞性睡眠呼吸暂停对老年2型糖尿病患者心脏结构和功能的影响

The impact of obstructive sleep apnea on cardiac structure and function in elderly patients with type 2diabetes mellitus

目的︰探讨阻塞性睡眠呼吸暂停(OSA)对老年2型糖尿病(T2DM)患者心脏结构和功能的影响。方法︰病例对照研究,选取在天津医科大学总医院保健医疗部就诊年龄≥65岁的T2DM患者,最终纳入资料完整者61例。对所有患者行多导睡眠图(PSG)监测,根据是否合并OSA分为单纯T2DM组和OSA合并T2DM组,比较两组患者心脏结构和功能指标的差异,同时比较轻度OSA组和中/重度OSA组患者心脏结构和功能指标的差异,采用Pearson相关和多元线性回归分析OSA与T2DM患者心脏结构和功能的相关性。结果OSA合并T2DM组患者左心室射血分数(LVEF)为(52.38±4.70)%,与单纯T2DM组(56.34±5.92)%比较明显降低(t=2.892,P=0.005),OSA合并T2DM组患者右心室前后径、室间隔厚度、左心室后壁厚度分别为(21.50±1.49)mm,(10.21±0.88)mm、(10.42±0.83)mm,与单纯T2DM组(20.55±1.05)mm、(9.52±1.04)mm,(9.83±0.83)mm比较明显增厚(t=-2.670、-2.770、-2.716,P=0.010,0.007,0.009);OSA合并T2DM组患者中,中重度OSA组LVEF为(50.58±3.55)%,较轻度OSA组(55.83±4.83)%降低(t=3.813,P=0.001),中重度OSA组患者右心室前后径、室间隔厚度﹑左心室后璧厚度分别为(21.86±1.39)mm,(10.48±0.82)mm,(10.68±0.80)mm,较轻度OSA组(20.79±1.46)mm,(9.69±0.75)mm,(9.92±0.64)mm增厚(t=-2.231、-2.871、-2.943,P=0.032,0.007、0.006);Pearson相关分析结果显示,呼吸暂停低通气指数(AHI)与LVEF、右心室前后径、室间隔厚度、左心室后壁厚度相关(r=-0.425,0.340,0.458,0.473,均P=0.001,0.007、<0.001,<0.001);矫正年龄,体质指数(BMI)、收缩压、三酰甘油(TG)后,多元线性回归结果显示,AHI仍与LVEF、右心室前后径、室间隔厚度、左心室后壁厚度显著相关(β=-0.385、0.520,0.604,0.388,P=0.036、0.011,0.001,0.039)。结论OSA加重T2DM患者的心脏重构和收缩功能不全,这种心脏结构与功能的改变可能与间歇性缺氧的严重程度有关。

0bjective To investigate the impact of obstructive sleep apnea(OSA)on cardiacstructure and function in elderly patients with type 2 diabetes mellitus(T2DM).MethodsThis wasa case-control study.Elderly patients with T2DM aged 65 years and above at the Department of Geriatrics of Tianjin Medical University General Hospital were consecutively enrolled in this study,andeventually 61 patients with complete general information were included.All patients were examinedwith polysomnography(PSG).They were divided into the T2DM group and the T2DM+OSA groupbased on whether there was concurrent OSA.Differences in cardiac structure and function werecompared between the two groups and between patients with mild OSA and those with moderate-severe OSA.The correlation of OSA with cardiac structure and function in T2DM patients wasanalyzed by using Pearson correlation and multiple linear regression analysis.Results The leftventricular ejection fraction(LVEF)was lower in the T2DM+OSA group than in the T2DM group(52.38±4.70%vs.56.34±5.92%,t=2.892,P=0.005).The anteroposterior diameter of the rightventricle,inter-ventricular septum thickness and left ventricular posterior wall thickness increased inthe T2DM+OSA group compared with the T2DM group(21.50±1.49 mm rs.20.55±1.05 mm,10.21±0.88 mm vs.9.52±1.04 mm,10.42±0.83 mm vs.9.83±0.83 mm,t=-2.670,-2.770and-2.716,P=0.010,0.007 and 0.009).LVEF was lower in patients with moderate-severe OSAthan in those with mald OSA group(50.58±3.55%vs.55.83±4.83%,t=3.813,P=0.001).Theanteroposterior diameter of the right ventricle,inter-ventricular septum thickness and left ventricularposterior wall thickness were greater in patients with moderate-severe OSA than in those with mildOSA(21.86±1.39 mm vs.20.79±1.46 mm,10.48±0.82 mm vs.9.69±0.75 mm,10.68±0.80mm vs.9.92±0.64 mm,t=-2.231,-2.871 and-2.943,P=0.032,0.007 and 0.006).Pearsoncorrelation analysis showed that the Apnea Hypopnea Index(AHI)was correlated with LVEF,theanteroposterior dameter of the right ventricle,inter-ventricular septum thickness and left ventricularposterior wall thickness(r=-0.425,0.340,0.458 and 0.473,P=0.001,0.007,<0.001 and<0.001).After adjusting for age,body mass index,systolic blood pressure and triglycerides,multiplelinear regression analysis showed that AHI was also correlated with LVEF,the anteroposteriordiameter of the right ventricle,inter-ventricular septum thickness and left ventricular posterior wallthickness(β=-0.385,0.520,0.604 and 0.388,P=0.036,0.011,0.001 and 0.039).ConclusionsOSA aggravates cardiac remodeling and systolic insufficiency in T2DM patients and may be related tothe severity of intermittent hypoxia.