呼吸事件相关的血氧饱和度下降速率与2型糖尿病及其血管并发症的相关性研究

A study on the correlation between respiratory event-related oxygen desaturation rate and type 2 diabetes mellitus with diabetic vascular complications

摘要

目的: 探讨阻塞性睡眠呼吸暂停（obstructive sleep apnea，OSA）患者呼吸事件相关的血氧饱和度下降速率（oxygen desaturation rate，ODR）与2型糖尿病（type 2 diabetes mellitus，T2DM）及其血管并发症的相关性。方法: 回顾性纳入2023年6月—2024年12月于南京医科大学附属淮安第一医院接受多导睡眠监测（polysomnography，PSG）并确诊为OSA的493例患者，其中T2DM组218例，无T2DM组275例。基于PSG血氧饱和度（peripheral oxygen saturation，SpO₂）信号计算呼吸事件相关事件级ODR（ΔSpO₂/Δt），个体水平取整夜事件ODR的中位数。按ODR三分位数分组，以Low-ODR组为对照，采用多因素Logistic回归分析评估ODR及传统PSG指标与T2DM及其血管并发症患病风险的相关性。结果: 两组患者的年龄、呼吸暂停低通气指数（apnea-hypopnea index，AHI）及氧减指数（oxygen desaturation index，ODI）无显著差异，而T2DM组的ODR显著高于无T2DM组[0.50（0.35，0.67）%/s vs. 0.38（0.29，0.52）%/s，P<0.001]。多因素Logistic回归分析显示，High-ODR与T2DM（OR=2.96，95%CI：1.73~5.09，P<0.001）及其血管并发症（OR=3.91，95%CI：1.04~14.66，P<0.05）显著相关。性别分层分析进一步显示，ODR与T2DM患病风险之间的关联仅在男性患者中具有统计学意义，High-ODR组男性T2DM的OR为Low-ODR组的3.64倍（OR=3.64，95%CI：1.78~7.43，P<0.001）。结论: ODR与OSA患者T2DM及其血管并发症显著相关，并呈现出性别差异。

Abstract

Objective: To investigate the correlation between the oxygen desaturation rate（ODR）associated with obstructive respiratory events and type 2 diabetes mellitus（T2DM）as well as its vascular complications in patients with obstructive sleep apnea（OSA）. Methods: A total of 493 patients with OSA who underwent polysomnography（PSG）at the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University between June 2023 and December 2024 were retrospectively included. Patients were divided into two groups：the T2DM group（n=218）and the non-T2DM group（n=275）. Based on the peripheral oxygen saturation（SpO₂）signal from PSG，event-level ODR（ΔSpO₂/Δt）associated with obstructive respiratory events was calculated；individual-level ODR was defined as the median across all-night events. Participants were stratified into tertiles according to ODR（with the Low-ODR group as reference），and a multivariable logistic regression model was constructed to assess the associations of ODR and conventional PSG parameters with the risk of T2DM and diabetic vascular complications. Results: There were no significant differences in age，apnea-hypopnea index（AHI），or oxygen desaturation index（ODI）between the two groups. However，the ODR was significantly higher in the T2DM group than that in the non-T2DM group[0.50（0.35，0.67）%/s vs. 0.38（0.29，0.52）%/s，P<0.001]. Multivariable logistic regression analysis showed that，High-ODR was significantly associated with T2DM（OR=2.96，95%CI：1.73-5.09，P<0.001）and diabetic vascular complications（OR=3.91，95%CI：1.04-14.66，P<0.05）. Stratified analysis by sex further revealed that the association between ODR and the risk of T2DM was statistically significant only in male patients；the OR for T2DM in the males of High-ODR group was 3.64 times of the males in Low-ODR group（OR=3.64，95%CI：1.78-7.43，P<0.001）. Conclusion: ODR is significantly associated with T2DM and its vascular complications in patients with OSA，and this association exhibits gender-related differences.

关键词

血氧饱和度下降速率 / 阻塞性睡眠呼吸暂停 / 2型糖尿病 / 糖尿病血管并发症

Key words

oxygen desaturation rate / obstructive sleep apnea / type 2 diabetes mellitus / diabetic vascular complication

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基金资助

国家自然科学基金(82370089)