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Sleep apnea linked to microvascular complications in type 2 diabetes
Various parameters of obstructive sleep apnea are associated with diabetic neuropathy and estimated glomerular filtration rate in type 2 diabetes, according to recent study findings.
In a cross-sectional study, researchers analyzed data from 880 adults with type 2 diabetes admitted to 12 hospitals across six cities in China between September 2012 and February 2013 (55.6% men; mean age, 59 years; mean BMI, 25.1 kg/m²; mean diabetes duration, 7.6 years). Participants underwent one night of sleep monitoring using the ApneaLink (ResMed) to record apnea–hypopnea index, oxygen desaturation index, oxygen saturation and cumulative time of oxygen saturation less than 90% or 85% (CT90% and CT85%, respectively). Chronic diabetes complications were noted in medical charts.
Within the cohort, 30.2% had diabetic retinopathy; 4.1% had proliferative diabetic retinopathy; 40.4% had diabetic neuropathy; 57.8% had diabetic peripheral neuropathy. Among patients with diabetic neuropathy, 24.6% had microalbuminuria; 11.7% had macroalbuminuria; 4.1% had renal insufficiency.
Researchers found that CT90% was independently associated with diabetic nephropathy after adjusting for age, sex, diabetes duration, HbA1c, BMI, hypertension and use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker drugs within 1 week (OR = 1.002; 95% CI, 1-1.003).
Each stage of diabetic neuropathy was associated with increasing parameters of obstructive sleep apnea with several persisting after adjustment. Using logistic regression analysis, researchers found that oxygen saturation and CT90% were associated with microalbuminuria; CT90% and CT85% were associated with macroalbuminuria; oxygen desaturation index, oxygen saturation and CT85% were associated with renal insufficiency.
The eGFR independently correlated with oxygen desaturation index (beta = –0.172; P = .029) and the lowest oxygen saturation (beta = 0.354; P = .004) after adjustments.
“From the relatively limited previously published evidence and the results of the present study, the parameters of [obstructive sleep apnea] appear to have different significance in association with diabetes complications,” the researchers wrote. “We postulate that for microvascular complications in diabetes, the direct indicators of nocturnal hypoxemia may contribute more to the progression of these indicators. Our finding that CT90% was markedly associated with [diabetic neuropathy] and albuminuria may suggest that the total time of hypoxemia rather than the frequency of desaturation was more important to [diabetic neuropathy].” – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.