睡眠时间和睡眠障碍与老年2型糖尿病视网膜病变的关系

Association between sleep time,sleep disorder and retinopathy in elderly patients with type 2 diabetes mellitus

目的评估客观测量的睡眠时间、睡眠障碍与糖尿病视网膜病变(DR)之间的关系。方法连续选取2018年8月至2020年8月海南省人民医院眼科收治的290例老年DR患者纳入DR组。同时从我科选取630例无视网膜病变的2型糖尿病患者作为对照组。通过多导睡眠图测定睡眠时间、呼吸暂停低通气指数(AHI)和最低氧饱和度(SaO_(2))。睡眠障碍采用Epworth嗜睡量表和失眠严重度指数及多导睡眠图仪同时进行评估。使用光学相干断层扫描仪(Spectralis HRA+OCT)测量每只眼的中央视网膜厚度(CRT),以观察糖尿病性黄斑水肿程度。次要观察指标包括糖尿病性黄斑水肿(DME),威胁视力的DR(VTDR)。结果两组受试者的性别、高血压患者比例、中度阻塞性睡眠呼吸暂停、睡眠时间短、白天过度嗜睡、失眠严重程度指数、糖尿病持续时间、呼吸暂停低通气指数、睡眠时间比较差异均有统计学意义(P<0.05);多因素Logistic回归分析结果显示:中度以上阻塞性睡眠呼吸暂停、AHI、睡眠时间短是老年2型糖尿病患者DR的独立危险因素(P<0.05),中度以上阻塞性睡眠呼吸暂停、AHI、低SaO_(2)是老年2型糖尿病VTDR的独立影响因素(P<0.05),失眠严重程度指数是老年2型糖尿病黄斑水肿的独立影响因素(P<0.05)。结论中度及以上阻塞性睡眠呼吸暂停、AHI、睡眠时间短和最低SaO_(2)是老年2型糖尿病患者DR和VTDR的独立危险因素,而失眠严重程度指数是老年2型糖尿病黄斑水肿的独立影响因素。

Objective To explore the association between objectively measured sleep time,sleep disturbance and diabetic retinopathy(DR).Methods A total of 290 elderly patients with DR admitted to Department of Ophthalmology,Hainan General Hospital from August 2018 to August 2020 were consecutively selected into the DR group.At the same time,630 patients with type 2 diabetes mellitus without retinopathy were selected as the control group.The sleep time,apnea-hypopnea index(AHI),and minimum oxygen saturation(SaO_(2))were measured by poly-somnography.Sleep disorders were assessed simultaneously using Epworth Sleepiness Scale,Insomnia Severity Index,and Poly-somnography.The optical coherence tomography(Spectralis HRA+OCT)was used to measure the central retinal thickness(CRT)of each eye to observe the degree of diabetic macular edema.Secondary observation indicators included diabetic macular edema(DME)and vision threated DR(VTDR).Results The two groups were significantly different in gender,proportion of hypertension,above moderate obstructive sleep apnea,short sleep time,excessive daytime sleepiness,insomnia severity index,duration of diabetes,apnea hypopnea index,and sleep time(P<0.05).Multivariate logistic regression analysis showed that obstructive sleep apnea,AHI,and short sleep duration were independent risk factors for DR in elderly patients with type 2 diabetes(P<0.05).Low SaO_(2) is an independent influencing factor of VTDR in elderly type 2 diabetes mellitus(P<0.05),and the insomnia severity index is an independent influencing factor of macular edema in elderly type 2 diabetes mellitus(P<0.05).Conclusion Obstructive sleep apnea,AHI,short sleep duration,and low SaO_(2) are independent risk factors for DR and VTDR in elderly type 2 diabetic patients,and the insomnia severity index is an independent influencing factor of macular edema in elderly patients with type 2 diabetic mellitus.