老年女性阻塞性睡眠呼吸暂停综合征患者糖尿病前期患病率及影响因素分析

Analysis of the prevalence and influencing factors of prediabetes in elderly female patients with obstructive sleep api syndrome

目的 分析老年女性阻塞性睡眠呼吸暂停综合征(OSAS)患者糖尿病前期(prediabetes mellitus,PreDM)的患病率及影响因素。方法 本研究为多中心横断面研究。连续纳入2015年1月~2017年10月经多导睡眠监测首诊的老年女性OSAS患者381例,收集研究对象的一般资料、临床病史和睡眠参数指标,以PreDM的合并有无分为PreDM组(n=148例)和非PreDM组(n=233例)。采用多因素logistic回归,分析老年女性OSAS患者和不同OSAS分度组PreDM风险的影响因素。结果 与非PreDM组相比,PreDM组患者的年龄更高,吸烟、饮酒、临床病史中的颈动脉粥样硬化、高脂血症史占比及睡眠参数指标中的平均呼吸暂停时间、平均血氧饱和度水平(mean oxygen saturation,MSpO_(2))水平均更高,最低氧饱和度(lowest oxygen saturation,LSpO_(2))水平更低(P<0.05)。PreDM的总患病率为38.85%,轻度OSAS组、中度OSAS组和重度OSAS组患者的PreDM患病率分别为35.71%、22.76%和54.79%。多因素Logistic回归分析结果显示,年龄(OR=1.13,95%CI=1.08~1.18)、平均呼吸暂停时间(OR=1.09,95%CI=1.05~1.14)、饮酒(OR=3.42,95%CI=1.05~11.12)、吸烟(OR=1.94,95%CI=1.13~3.35)、睡眠呼吸暂停低通气指数(AHI)(OR=1.03,95%CI=1.01~1.05)、颈动脉粥样硬化史(OR=1.94,95%CI=1.18~3.17)和高脂血症史(OR=2.38,95%CI=1.47~3.86)是老年女性OSAS患者PreDM风险的独立危险因素。进一步的亚组分析结果显示,年龄(OR=1.33,95%CI=1.11~1.60)、氧饱和度<90%的时间(TSA90)(OR=1.01,95%CI=1.02~1.03)和体质量指数(BMI)(OR=1.15,95%CI=1.03~1.28)是轻度OSAS组患者PreDM风险的独立危险因素;年龄(OR=1.11,95%CI=1.03~1.20)、总睡眠时间(total sleep time,TST)(OR=1.25,95%CI=1.12~1.40)、MSpO2(OR=1.13,95%CI=1.05~1.22)、高脂血症(OR=1.14,95%CI=1.05~1.23)和平均呼吸暂停时间(OR=1.26,95%CI=1.13~1.40)是中度OSAS组患者PreDM风险的独立危险因素;年龄(OR=1.09,95%CI=1.02~1.16)、高脂血症史(OR=3.09,95%CI=1.35~7.08)、LSpO_(2)(OR=1.12,95%C I=1.0 6~1.18)、平均呼吸暂停时间(OR=1.0 7,95%C I=1.0 2~1.12)和饮酒(OR=1.10,95%CI=1.06~1.15)是重度OSAS组患者PreDM风险的独立危险因素。结论 老年女性OSAS患者的PreDM患病率较高,随着OSAS严重程度分度的增加,PreDM患病率呈先下降后上升的近似“U”形增长趋势。年龄、平均呼吸暂停时间、饮酒、吸烟、AHI、高脂血症和颈动脉粥样硬化是老年女性OSAS患者PreDM风险的独立危险因素。

OBJECTIVE To analyze the prevalence and its influencing factors of prediabetes(PreDM)in elderly women with obstructive sleep apnea syndrome(OSAS).METHODS This study was a multicenter cross-sectional study.A total of 381 elderly female OSAS patients who were first diagnosed by polysomnography from January 2015 to October 2017 were included in multiple centers.The general data,clinical history and sleep parameters of the subjects were collected.The patients was divided into PreDM group(148 cases)and non-PreDM group(233 cases).Multivariate logistic regression was used to analyze the risk factors of PreDM in elderly female OSAS patients and different OSAS classification groups.RESULTS Compared with the non-PreDM group,the patients in the PreDM group were older,and the smoking,drinking,the proportion of carotid atherosclerosis in clinical history,the history of hyperlipidemia and the average apnea time and mean blood oxygen saturation(MSpO_(2))were higher,while the lowest oxygen saturation(LSpO_(2))was lower(P<0.05,P<0.01).The total prevalence of PreDM was 38.85%.The prevalence of PreDM in mild OSAS group,moderate OSAS group and severe OSAS group were 35.71%,22.76%and 54.79%,respectively.Multivariate Logistic regression analysis showed that age(OR=1.13,95%CI=1.08-1.18),mean time of apnea(OR=1.09,95%CI=1.05-1.14),drinking(OR=3.42,95%CI=1.05-11.12),smoking(OR=1.94,95%CI=1.13~3.35),sleep apnea hypopnea index(AHI,OR=1.03,95%CI=-1.01-1.05),history of carotid atherosclerosis(OR=1.94,95%CI=1.18-3.17)and history of hyperlipidemia(OR-2.38,95%CI-1.47-3.86)were the independent risk factors for PreDM in elderly women with OSAS.Further subgroup analysis showed that age(OR=1.33,95%CI=1.11-1.60),time of oxygen saturation<90%(TSA90,OR=1.01,95%CI=1.02-1.03)and body mass index(BMI,OR=1.15,95%CI=1.03-1.28)were independent risk factors for PreDM in patients with mild OSAS.Age(OR=1.11,95%CI=1.03-1.20),total sleep time(TST,OR=1.25,95%CI=1.12-1.40),MSpO_(2)(OR=1.13,95%CI=1.05-1.22),hyperlipidemia(OR=1.14,95%CI=1.05-1.23)and mean apnea time(OR=1.26,95%CI-1.13-1.40)were independent risk factors for PreDM in patients with moderate OSAS.Age(OR=1.09,95%CI=1.02-1.16),history of hyperlipidemia(OR=3.09,95%CI=1.35-7.08),LSpO_(2)(OR=1.12,95%CI=1.06-1.18),mean apnea time(OR=1.07,95%CI=1.02-1.12)and alcohol consumption(OR=1.10,95%CI=1.06-1.15)were independent risk factors for PreDM in patients with severe OSAS.CONCLUSION The prevalence of PreDM in elderly women with OSAS is high.With the serious degree of OSAS increased,the prevalence of PreDM decreased first and then increased,which is similar to a"U"trend.Age,mean apnea time,alcohol consumption,smoking,AHI,hyperlipidemia,and carotid atherosclerosis were independent risk factors for preDM in elderly women with OSAS.