2型糖尿病患者睡眠呼吸暂停与糖尿病黄斑水肿相关性评估

Evaluation of the correlation between sleep apnea-hypopnea and diabetic macular edema in patients with type 2 diabetes mellitus

目的探讨2型糖尿病患者阻塞性睡眠呼吸暂停(OSA)与糖尿病黄斑水肿(DME)的关系。方法前瞻性连续纳入2018年11月至2019年9月在台州市第一人民医院就诊的99例2型糖尿病患者,使用谱域光学相干断层扫描技术诊断DME。依据病情将患者分为DME组(DME+组,n=38)和无DME组(DME-组,n=61)。所有患者均进行多导睡眠图(PSG)检测。采用单因素和多因素logistic回归分析考察OSA是否是黄斑水肿的独立危险因素。结果DME+组平均呼吸暂停低通气指数(AHI)[43.95(13.5,87.3)]高于DME-组[35.18(3.55,90.7)],差异有统计学意义(P<0.05)。DME+组患者中重度OSA患者呼吸暂停低通气指数高于DME-组(97.37%vs.78.69%),差异有统计学意义(P=0.001)。logistic多因素回归校正混杂因素后,AHI>15[OR(95%CI):4.52(1.47~12.01),P<0.001],动脉血氧饱和度低于90%的累积时间(CT90%)≤10%[OR(95%CI):6.39(1.25~32.69),P=0.026]是2型糖尿病发生DME的独立危险因素。AHI和CT90%诊断DME的曲线下面积分别为0.722和0.634,临界值分别为AHI≥37和CT90%≥10。结论2型糖尿病患者AHI>37和CT90%≥10与DME高度相关。

Objective To investigate the relationship between obstructive sleep apnea-hypopnea(OSA)and diabetic macular edema(DME)in patients with type 2 diabetes mellitus.Methods A total of 99 patients with type 2 diabetes mellitus who visited Taizhou First People′s Hospital in Zhejiang Province from November 2018 to September 2019 were prospectively and consecutively included.DME was diagnosed using spectral-domain optical coherence tomography.Patients were divided into the DME group(DME+group,n=38)and the non-DME group(DME-group,n=61)according to their condition.Polysomnogram(PSG)was performed in all patients.Univariate and multivariate logistic regression analyses were used to investigate whether OSA was an independent risk factor for macular edema.Results The mean apnea-hypopnea index(AHI)in the DME+group(43.95[13.5,87.3])was significantly higher than that(35.18[3.55,90.7])in the DME-group and the difference was statistically significant(P=0.034).The number of patients with apnea-hypopnea index(AHI)>30 in patients with moderate to severe OSA was higher in the DME+group than in the DME-group(97.37%vs.78.69%),and the difference was statistically significant(P=0.001).Logistic multivariate regression after adjustment for confounders showed AHI>15(OR[95%CI]:4.52[1.47-12.01],P<0.001)and cumulative time of SPO2 below 90%(CT90%)≤10%(OR[95%CI]∶6.39[1.25-32.69],P=0.026)were independent risk factors for DME in type 2 diabetes mellitus.The area under the curve for the diagnosis of DME was 0.722,and 0.634 for AHI and CT90%,respectively,and the cut-off values were AHI≥37 and CT90%≥10,respectively.Conclusion AHI>37 and CT90%≥10 are highly associated with DME in patients with type 2 diabetes mellitus.