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Simonson M, Li Y, Zhu B, McAnany JJ, Chirakalwasan N, Sutabutr Vajaranant T, Hanlon EC, Pannain S, Anothaisintawee T, Reutrakul S. Multidimensional sleep health and diabetic retinopathy: Systematic review and meta-analysis. Sleep Med Rev 2024; 74:101891. [PMID: 38118339 PMCID: PMC10963161 DOI: 10.1016/j.smrv.2023.101891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/24/2023] [Accepted: 12/04/2023] [Indexed: 12/22/2023]
Abstract
Diabetic retinopathy (DR) is one of the most prevalent microvascular diabetic complications. Poor sleep health and obstructive sleep apnea (OSA) are risk factors for diabetes and poor glycemic control. Recent studies have suggested associations between poor sleep health/OSA and DR. Furthermore, there have been suggestions of melatonin dysregulation in the context of DR. We conducted a systematic review and meta-analysis exploring the associations between multidimensional sleep health (duration, satisfaction, efficiency, timing/regularity and alertness), OSA and melatonin with DR. Forty-two studies were included. Long, but not short sleep, was significantly associated with DR, OR 1.41 (95%CI 1.21, 1.64). Poor sleep satisfaction was also significantly associated with DR, OR 2.04 (1.41, 2.94). Sleep efficiency and alertness were not associated with DR, while the evidence on timing/regularity was scant. Having OSA was significantly associated with having DR, OR 1.34 (1.07, 1.69). Further, those with DR had significantly lower melatonin/melatonin metabolite levels than those without DR, standardized mean difference -0.94 (-1.44, -0.44). We explored whether treating OSA with continuous positive airway pressure (CPAP) led to improvement in DR (five studies). The results were mixed among studies, but potential benefits were observed in some. This review highlights the association between poor multidimensional sleep health and DR.
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Affiliation(s)
- Matthew Simonson
- College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Yanliang Li
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Bingqian Zhu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - J Jason McAnany
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Naricha Chirakalwasan
- Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Thailand; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Erin C Hanlon
- Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism, University of Chicago, Chicago, IL, USA
| | - Silvana Pannain
- Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism, University of Chicago, Chicago, IL, USA
| | - Thunyarat Anothaisintawee
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Sirimon Reutrakul
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA; Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois, Chicago, USA.
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Ding S, Zhang P, Wang L, Wang D, Sun K, Ma Y, Wang H, Xu C, Zhang R, Zhang X, Wang H, Zhao F, Li X, Ji L, Guo L. Prevalence of obstructive sleep apnoea syndrome in hospitalized patients with type 2 diabetes in Beijing, China. J Diabetes Investig 2022; 13:1889-1896. [PMID: 35778970 PMCID: PMC9623507 DOI: 10.1111/jdi.13868] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022] Open
Abstract
Aims/Introduction To estimate the prevalence, and patient clinical and demographic profile, as well as risk factors associated with obstructive sleep apnea syndrome (OSAS) in hospitalized patients with type 2 diabetes mellitus in Beijing, China. Materials and Methods Hospitalized adult patients with type 2 diabetes mellitus were consecutively screened and invited for an overnight polysomnography from four hospitals in Beijing, China, from May 2016 to February 2017. We used the American Academy of Sleep Medicine 2012 polysomnography recording techniques and scoring criteria to identify the type of apnea and the severity of OSAS. The χ2‐test was used to evaluate differences between groups regarding the prevalence, and demographic and other clinical parameters. Results A total of 735 patients were found eligible for the study, of whom 309 patients completed the overnight polysomnography. The mean age of the patients was 58.2 ± 10.9 years, and most (67.3%) were men. The prevalence of overall (apnea hypopnea index ≥5/h), moderate‐to‐severe (apnea hypopnea index ≥15/h) and severe (apnea hypopnea index ≥30/h) OSAS was 66.3% (95% confidence interval 60.8–71.6%), 35.6% (95% confidence interval 30.3–41.2%) and 16.5% (95% confidence interval 12.5–21.1%), respectively. Central and mixed apnea contributed 12% to all sleep‐disordered breathing. With the aggravation of OSAS, the combined prevalence for central, mixed and obstructive apnea increased from 57% to 70%. We found OSAS to be associated with older age, obesity, self‐reported snoring and apnea, and diabetes complications. Conclusions Guidelines on screening and treatment of OSAS among hospitalized patients with diabetes are needed to direct the routine practice for diabetes endocrinologists for optimal clinical care of such patients.
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Affiliation(s)
- Shan Ding
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine Chinese Academy of Sciences Beijing P.R. China
| | - Puhong Zhang
- The George Institute for Global Health at Peking University Health Science Center Beijing P.R. China
- Faculty of Medicine University of New South Wales Sydney Australia
| | - Li Wang
- Department of Endocrinology, Xuanwu Hospital Capital Medical University Beijing P.R. China
| | - Du Wang
- The George Institute for Global Health at Peking University Health Science Center Beijing P.R. China
| | - Kaige Sun
- The George Institute for Global Health at Peking University Health Science Center Beijing P.R. China
| | - Yahui Ma
- Department of Endocrinology, Xuanwu Hospital Capital Medical University Beijing P.R. China
| | - Hongbing Wang
- Sleep Center Lab, Beijing Hospital, National Center of Gerontology Beijing P.R. China
| | - Chun Xu
- Department of Endocrinology, The Third Medical Center of Chinese Hospital of People’s Liberation Army Beijing P.R. China
| | - Rui Zhang
- Department of Endocrinology and Metabolism Peking University People’s Hospital No. 11, Xizhimen Nan Da Jie, Xicheng District Beijing China
| | - Xianbo Zhang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine Chinese Academy of Sciences Beijing P.R. China
| | - Hongyu Wang
- Department of Endocrinology, The Third Medical Center of Chinese Hospital of People’s Liberation Army Beijing P.R. China
| | - Fang Zhao
- The George Institute for Global Health at Peking University Health Science Center Beijing P.R. China
| | - Xian Li
- The George Institute for Global Health at Peking University Health Science Center Beijing P.R. China
| | - Linong Ji
- Department of Endocrinology and Metabolism Peking University People’s Hospital No. 11, Xizhimen Nan Da Jie, Xicheng District Beijing China
| | - Lixin Guo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine Chinese Academy of Sciences Beijing P.R. China
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Kaba Q, Tai F, Al-Awadi A, Somani S. Examining the Relationship Between Diabetic Macular Edema, and Obstructive Sleep Apnea. Clin Ophthalmol 2022; 16:1215-1223. [PMID: 35480621 PMCID: PMC9037844 DOI: 10.2147/opth.s354087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/08/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose This prospective cohort study examined the relationship between diabetic macular edema (DME), diabetic retinopathy (DR) and obstructive sleep apnea (OSA) in patients after 1 year of treatment with anti-VEGF injection and/or continuous positive airway pressure (CPAP). Patients and Methods The study included adults with type 1 or 2 diabetes mellitus with diabetic retinopathy. Polysomnography metrics were measured at baseline. Ophthalmologic metrics were measured at baseline, six-month (6m) and twelve-month (12m) follow-up. All DME+ patients received standard care, and all OSA+ patients were advised continuous positive airway pressure (CPAP). Logistic regression between DR severity and OSA severity was performed. Analysis of variance (ANOVA) was performed between subgroups. Results Seventy-four eyes of 49 patients with DR were included. Prevalence of OSA was significantly higher in the DME+ group (70.7%) than DME- group (42.4%, p < 0.05). A significantly lower average minimum SaO2 was noted in OSA+DME+ (81.74%) than OSA+DME- eyes (88.23%, p < 0.05). Logistic regression analysis of ophthalmological and sleep metrics showed no correlation between DR and OSA severity. CPAP adherence was 20% (6/30) in the OSA+DME+ cohort and 36% (5/14) in the OSA+DME- cohort. At 12m, CPAP-adherent OSA+DME+ showed significantly lower DR severity score (1.00 ± 0.0) than CPAP non-adherent OSA+DME+ (1.36 ± 0.80, p = 0.042). No significant patterns were noted for visual acuity and mean central retinal thickness. Conclusion DME is associated with the presence of OSA. Minimum SaO2 is a significant OSA clinical variable for DME. DR severity is not associated with OSA severity. CPAP coupled with intravitreal anti-VEGF therapy may be helpful for reducing DR severity in DME+ eyes. Presence of OSA may diminish intravitreal anti-VEGF efficacy on anatomical (mean CRT) and functional (VA) outcomes of DME.
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Affiliation(s)
- Qayim Kaba
- Cardiff University School of Medicine, Cardiff, UK
| | - Felicia Tai
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ahmad Al-Awadi
- Mayo Clinic School of Graduate Medical Education, Jacksonville, FL, USA
| | - Sohel Somani
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Uptown Eye Specialists, Brampton, Ontario, Canada
- William Osler Health Centre, Brampton, Ontario, Canada
- Correspondence: Sohel Somani, Uptown Eye Specialists, 401-7900 Hurontario Street, Brampton, ON, L6Y 0P6, Canada, Email
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Zheng C, Zheng X, Lin X, Ye J, Xu Z, Hu H, Wang W, Huang C, Tian J, Liu C. Visceral Adipose Tissue Indices Independently Correlated with Obstructive Sleep Apnea in Patients with Type 2 Diabetes. J Diabetes Res 2022; 2022:4950528. [PMID: 35187177 PMCID: PMC8853812 DOI: 10.1155/2022/4950528] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/19/2022] [Indexed: 11/18/2022] Open
Abstract
AIMS We aimed to explore whether visceral adiposity indices were significantly associated with obstructive sleep apnea (OSA) in type 2 diabetes (T2DM) patients. METHODS 100 patients with T2DM who underwent overnight polysomnography were analyzed in this study. Anthropometric data, lipid profiles, and glycemic parameters were recorded. Body fat percentage (BFP) and visceral adipose tissue area (VAT area) were collected from a whole body scan using dual-energy X-ray absorptiometry (DXA). Multivariate logistic regression analysis was performed to explore the associations of AHI with BFP, VAT area, and CVAI. RESULTS The prevalence rate of OSA was 80%, and the mean (±SD) of age was 47.0 ± 13.6 years. Apnea-hypopnea index (AHI) was significantly and positively associated with either VAT area (r = 0.433, p ≤ 0.001) or Chinese visceral adiposity index (CVAI) (r = 0.355, p ≤ 0.001) but not for BFP (r = 0.107, p = 0.294). Multivariate logistic regression analyses showed that VAT area and CVAI were significantly associated with increased risk of OSA, and the adjusted ORs were (95% CI) 1.025 (1.003-1.047, p = 0.023) and 1.018 (1.002-1.034, p = 0.030), respectively. However, there was no significant association between BFP and increased risk of OSA. CONCLUSIONS VAT area and CVAI were independent risk factors of OSA in the patients with T2DM.
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Affiliation(s)
- Caiyu Zheng
- Department of Endocrinology, Fujian Medical University Xiamen Humanity Hospital, Xiamen, Fujian Province, China
- School of Medicine, Xiamen University, Xiamen, Fujian Province, China
| | - Xuanling Zheng
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian Province, China
| | - Xiaoyan Lin
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian Province, China
| | - Jiawen Ye
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Ziqing Xu
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian Province, China
| | - Huixian Hu
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian Province, China
| | - Wengui Wang
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian Province, China
| | - Caoxin Huang
- Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, Fujian Province, China
- Xiamen Diabetes Institute, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian Province, China
| | - Jianqing Tian
- Department of Endocrinology, Fujian Medical University Xiamen Humanity Hospital, Xiamen, Fujian Province, China
| | - Changqin Liu
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian Province, China
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, Fujian Province, China
- Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, Fujian Province, China
- Xiamen Diabetes Prevention and Control Center, Xiamen, Fujian Province, China
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Ma D, Zeng J, Huang B, Yan F, Ye J, Chen Y, Zeng X, Zheng X, Xiao F, Lin M, Liu C, Li Z. Independent associations of thyroid-related hormones with hepatic steatosis and insulin resistance in euthyroid overweight/obese Chinese adults. BMC Gastroenterol 2021; 21:431. [PMID: 34794374 PMCID: PMC8603528 DOI: 10.1186/s12876-021-02011-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/02/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The aim of the study is to explore the independent association of free triiodothyronine (FT3), free thyroxine (FT4) and thyroid stimulating hormone (TSH) with hepatic steatosis and insulin resistance. METHODS A cross-sectional study of 88 overweight/obese adults who underwent anthropometric measurements [BMI, waist circumference (WC) and waist-to-height ratio (WHtR)], hepatic steatosis assessment (FibroScan) and thyroid-related hormones tests was conducted from 2018 to 2020 in Xiamen, China. RESULTS Subjects with increasing tertiles of FT3 showed significantly higher levels of controlled attenuation parameter (CAP) ((295.4 ± 44.1, 290.1 ± 68.2 and 331.7 ± 43.6 (dB/m) for tertile 1-3, respectively, p = 0.007) and fatty liver index (FLI) score (47.7 (33.9-60.8), 61.5 (45.1-88.9) and 90.5 (84.5-94.8), respectively, p < 0.001). FT3 significantly and positively correlated with obesity index (BMI, WC, and WHtR), homeostatic model assessment of insulin resistance (HOMA-IR) and hepatic steatosis (CAP and FLI). Multivariable linear regression analyses with adjustment for potential confounding factors showed FT3 was independently associated with BMI (regression coefficient (β (95%CI): 0.024 (0.004-0.043), p = 0.020), HOMA-IR (β (95%CI): 0.091 (0.007-0.174), p = 0.034), CAP (β (95%CI): 25.45 (2.59-48.31), p = 0.030) and FLI (β (95%CI): 0.121 (0.049-0.194), p = 0.001). Neither FT4 nor TSH was significantly associated with any indicators of obesity, insulin resistance or hepatic steatosis. CONCLUSIONS Increased FT3, but not FT4 or TSH, was independently associated with higher risks of hepatic steatosis and insulin resistance in euthyroid overweight/obese Chinese adults. Trial registration Registration is not applicable for our study.
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Affiliation(s)
- Danyan Ma
- School of Medicine, Xiamen University, Xiamen, China
| | - Jinyang Zeng
- Department of Endocrinology and Diabetes, The First Affiliated Hospital, Xiamen University, Xiamen, China.,Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen, China
| | - Bingkun Huang
- Department of Endocrinology and Diabetes, The First Affiliated Hospital, Xiamen University, Xiamen, China.,Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen, China
| | - Fangfang Yan
- Department of Endocrinology and Diabetes, The First Affiliated Hospital, Xiamen University, Xiamen, China.,Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen, China
| | - Jiawen Ye
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Yun Chen
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Xiying Zeng
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Xin Zheng
- Department of Endocrinology and Diabetes, The First Affiliated Hospital, Xiamen University, Xiamen, China.,Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen, China
| | - Fangsen Xiao
- Department of Endocrinology and Diabetes, The First Affiliated Hospital, Xiamen University, Xiamen, China.,Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen, China
| | - Mingzhu Lin
- Department of Endocrinology and Diabetes, The First Affiliated Hospital, Xiamen University, Xiamen, China.,Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen, China
| | - Changqin Liu
- Department of Endocrinology and Diabetes, The First Affiliated Hospital, Xiamen University, Xiamen, China. .,Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Xiamen, China. .,Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China.
| | - Zhibin Li
- Epidemiology Research Unit, Translational Medical Research Center, The First Affiliated Hospital, Xiamen University, Xiamen, China.
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The Associations of Obstructive Sleep Apnea and Eye Disorders: Potential Insights into Pathogenesis and Treatment. CURRENT SLEEP MEDICINE REPORTS 2021. [DOI: 10.1007/s40675-021-00215-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Abstract
Purpose of Review
Obstructive sleep apnea (OSA) patients are at significantly increased risks for cardiovascular and cerebrovascular morbidities. Recently, there has been heightened interest in the association of OSA with numerous ocular diseases and possible improvement of these conditions with the initiation of OSA treatment. We reviewed the current evidence with an emphasis on the overlapping pathogeneses of both diseases.
Recent Findings
Currently available literature points to a substantial association of OSA with ocular diseases, ranging from those involving the eyelid to optic neuropathies and retinal vascular diseases. Since the retina is one of the highest oxygen-consuming tissues in the body, the intermittent hypoxia and hypercapnia ensuing in OSA can have deleterious effects on ocular function and health. Tissue hypoxia, autonomic dysfunction, microvascular dysfunction, and inflammation all play important roles in the pathogenesis of both OSA and ocular diseases. Whether OSA treatment is capable of reversing the course of associated ocular diseases remains to be determined. It is anticipated that future therapeutic approaches will target the common underlying pathophysiologic mechanisms and promote favorable effects on the treatment of known associated ocular diseases.
Summary
Emerging evidence supports the association of ocular diseases with untreated OSA. Future studies focusing on whether therapeutic approaches targeting the common pathophysiologic mechanisms will be beneficial for the course of both diseases are warranted.
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Liang J, Cai H, Liang G, Liu Z, Fang L, Zhu B, Liu B, Zhang H. Educational attainment protects against type 2 diabetes independently of cognitive performance: a Mendelian randomization study. Acta Diabetol 2021; 58:567-574. [PMID: 33409669 DOI: 10.1007/s00592-020-01647-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/28/2020] [Indexed: 12/14/2022]
Abstract
AIMS Observational studies have reported a negative association between educational attainment and type 2 diabetes (T2D), but the causality remains largely unknown. The aim of this study is to investigate the potential causal effect of educational attainment on T2D and whether such an effect is independent of cognitive performance. METHODS We conducted two-sample Mendelian randomization (MR) analysis using genetic variants strongly associated with educational attainment and cognitive performance to estimate the causal associations with T2D, among 61,714 T2D cases and 593,952 controls. We also performed multivariable MR to explore the independent effects of educational attainment and cognitive performance on T2D risk. RESULTS In univariable MR, we found evidence that genetically predicted higher educational attainment [odds ratio (OR) 0.53 per 1-standard deviation (SD) increase; 95% confidence interval (CI) 0.47-0.60] and cognitive performance (OR 0.79 per 1-SD increase; 95%CI 0.69-0.91) were related to decreased risk of T2D. Our further multivariable MR results suggested that more years of education led to a reduced likelihood of T2D independently of cognitive performance (OR 0.52; 95%CI 0.42-0.64). However, the protective effect of cognitive performance on T2D was attenuated once educational attainment was controlled for (OR 1.08; 95%CI 0.88-1.32). CONCLUSIONS We provided evidence to suggest that educational attainment protects against T2D independently of cognitive performance, but does not support a negative causal association between cognitive performance and T2D independently of educational attainment. Education might represent a potential target for intervention to battle type 2 diabetes risk.
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Affiliation(s)
- Jialin Liang
- Department of Endocrinology and Metabolism, Zhongshan City People's Hospital, 2 East Sunwen Road, Zhongshan, 528403, Guangdong, China
| | - Huan Cai
- Department of Rehabilitation, Zhongshan City People's Hospital, 2 East Sunwen Road, Zhongshan, 528403, Guangdong, China
| | - Ganxiong Liang
- Department of Endocrinology and Metabolism, Zhongshan City People's Hospital, 2 East Sunwen Road, Zhongshan, 528403, Guangdong, China.
| | - Zhonghua Liu
- Department of Rehabilitation, Zhongshan City People's Hospital, 2 East Sunwen Road, Zhongshan, 528403, Guangdong, China
| | - Liang Fang
- Department of Rehabilitation, Zhongshan City People's Hospital, 2 East Sunwen Road, Zhongshan, 528403, Guangdong, China
| | - Baile Zhu
- Department of Endocrinology and Metabolism, Zhongshan City People's Hospital, 2 East Sunwen Road, Zhongshan, 528403, Guangdong, China
| | - Baoying Liu
- Department of Endocrinology and Metabolism, Zhongshan City People's Hospital, 2 East Sunwen Road, Zhongshan, 528403, Guangdong, China
| | - Hao Zhang
- Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, China.
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Higher Apnea-Hypopnea Index (AHI) and Oxygen Desaturation Index (ODI) Were Independently Associated with Increased Risks of Hypertension in Patients with T2DM: A Cross-Sectional Study. Int J Hypertens 2021; 2021:8887944. [PMID: 33552598 PMCID: PMC7846401 DOI: 10.1155/2021/8887944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/05/2021] [Indexed: 12/31/2022] Open
Abstract
Objective The current study aimed to explore the relationship between OSAS and hypertension and whether polysomnography (PSG) indices were independently associated with hypertension in patients with type 2 diabetes (T2DM). Methods This study recruited 316 T2DM patients. Multivariable logistic regression analyses were performed to determine the independent association of apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) with hypertension with adjustment for potential confounders. Results Among 316 patients, 130 (41.1%) and 204 (64.6%) had hypertension and OSAS, respectively. T2DM patients with hypertension showed significantly increased levels of AHI ((median (interquartile range)): 17.2 (5.7–34.9) vs. 5.7 (2.1–17.3) events/hour, p < 0.001), nonrapid eye movement AHI (NREM-AHI) (17.6 (5.5–36.5) vs. 5.2 (2.2–16.6) events/hour, p < 0.001), ODI (48.4 (21.9–78.0) vs. 22.6 (10.8–48.1) events/hour, p < 0.001), and severities of OSAS and decreased levels of lowest SaO2 ((mean ± standard deviation): 74.0 ± 10.4 vs. 77.3 ± 9.8, p = 0.004). Multivariable logistic regression analysis showed that higher levels of AHI, NREM-AHI, and ODI were significantly associated with increased risks of hypertension, and the adjusted odds ratios (ORs) with 95% CI were 1.026 (1.008–1.044, p = 0.004), 1.026 (1.009–1.044, p = 0.003), and 1.005 (1.001–1.010, p = 0.040), respectively. Compared with non-OSAS, severe OSAS was significantly associated with the risk of hypertension with the adjusted OR (95% CI) of 3.626 (1.609–8.172, p = 0.002), but associations of rapid eye movement AHI (REM-AHI) and lowest SaO2 with hypertension were not statistically significant. Conclusion Increased AHI, NREM-AHI, ODI, and severities of OSAS were significantly associated with higher risks of hypertension in T2DM patients. Detection and treatment of OSAS are needed to prevent hypertension in T2DM patients.
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Dong L, Lin M, Wang W, Ma D, Chen Y, Su W, Chen Z, Wang S, Li X, Li Z, Liu C. Lipid accumulation product (LAP) was independently associatedwith obstructive sleep apnea in patients with type 2 diabetes mellitus. BMC Endocr Disord 2020; 20:179. [PMID: 33298050 PMCID: PMC7727244 DOI: 10.1186/s12902-020-00661-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/03/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Lipid accumulation product (LAP) is a new index based on a combination of waist circumference (WC) and serum triglycerides (TG) reflecting lipid accumulation. In this cross-sectional study, we aimed to explore whether LAP was independently associated with obstructive sleep apnea (OSA) in Type 2 diabetes mellitus (T2DM) patients. METHODS A cross-sectional study of 317 T2DM patients who underwent overnight polysomnography (PSG) tests was conducted. The clinical data between non-OSA group and OSA group were compared. Multivariable linear regression and multivariable logistic regression analyses were performed to determine associations of LAP, with apnea-hypopnea index (AHI) and OSA. RESULTS Among 317 patients, 219 (69.1%) were men, and the mean ages (±SD) were 51.4 (±13.5) years for men and 54.6 (±15.1) years for women (p = 0.067). The prevalence rates of OSA were 63.0% for men and 68.4% for women (p = 0.357). LAP (log-transformed) was significantly correlated with AHI (log-transformed), with the Pearson's correlation coefficient of 0.170 (p = 0.002). With adjustment for potential confounding factors, multivariate linear regression analyses showed the association of LAP with AHI was not statistically significant, with the adjusted linear regression coefficients (95% CI) of per SD increase of LAP for AHI (log-transformed) was 0.092 (- 0.011-0.194, p = 0.080). Multivariate logistic regression analyses showed LAP was significantly associated with increased risk of OSA, with the adjusted OR (95%CI) of per SD increase of LAP of 1.639 (1.032-2.604, p = 0.036). However, as constituents of LAP, neither TG nor WC was significantly associated with AHI and OSA. CONCLUSION LAP was independently associated with OSA and might be used as a potential OSA risk marker in T2DM patients, beyond the general index of obesity.
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Affiliation(s)
- Lianqin Dong
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000, China
| | - Mingzhu Lin
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xaimen, 361003, China
- Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China
| | - Wengui Wang
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xaimen, 361003, China
| | - Danyan Ma
- School of Medicine, Xiamen University, Xiamen, China
| | - Yun Chen
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000, China
| | - Weijuan Su
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xaimen, 361003, China
- Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China
| | - Zheng Chen
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xaimen, 361003, China
- Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China
| | - Shunhua Wang
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xaimen, 361003, China
- Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China
| | - Xuejun Li
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xaimen, 361003, China
- Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China
| | - Zhibin Li
- Epidemiology Research Unit, The First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xiamen, 361003, China.
| | - Changqin Liu
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350000, China.
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, No.55 Zhenhai Road, Xaimen, 361003, China.
- Xiamen Clinical Medical Center for Endocrine and Metabolic Diseases, Fujian Province Key Laboratory of Diabetes Translational Medicine, Xiamen, China.
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