Association between obstructive sleep apnea severity and endothelial dysfunction in patients with type 2 diabetes

Cardiovascular Diabetology

Original Investigation

Marc Le Vaillant¹  Samir Henni²  Pierre Abraham²  Séverine Dubois³  Audrey Paris⁴  François Goupil⁴  Claire Sanguin⁵  Pierre Henri Ducluzeau⁶  Maria Carmen Martinez⁷  Vanessa Bironneau⁷  Ramaroson Andriantsitohaina⁷  Nicole Meslier⁸  Frédéric Gagnadoux⁸  Pascaline Priou⁸  Wojciech Trzépizur⁸ 

[1] Centre de Recherche Médecine, Sciences, Santé, Santé mentale, Société, CNRS UMR 8211, INSERM UMR U988-EHESS, Villejuif, France;Département de Médecine du Sport et Explorations Fonctionnelles Vasculaires, Université Bretagne Loire, CHU d’Angers, Angers, France;Département d’Endocrinologie, Diabétologie, Nutrition, Université Bretagne Loire, CHU d’Angers, Angers, France;Service de Pneumologie, Centre Hospitalier, Le Mans, France;Service d’Endocrinologie, Diabétologie, Centre Hospitalier, Le Mans, France;Unité d’Endocrinologie-Diabétologie-Nutrition, Pole de Médecine, CHRU de Tours, Tours, France;Université Bretagne Loire, INSERM UMR 1063, Angers, France;Université Bretagne Loire, INSERM UMR 1063, Angers, France;Département de Pneumologie, Université Bretagne Loire, CHU d’Angers, 4 Rue Larrey, 49100, Angers, France;

关键词: Obstructive sleep apnea;    Type 2 diabetes;    Endothelial function;    Peripheral arterial tonometry;    Reactive hyperemia index;   

DOI  :  10.1186/s12933-017-0521-y

 received in 2017-02-04, accepted in 2017-03-15,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundObstructive sleep apnea (OSA) and type 2 diabetes (T2D) are associated with endothelial dysfunction a main predictor of late cardiovascular (CV) events. Despite the high prevalence of OSA in patients with T2D, the impact of OSA severity on endothelial function has not been clearly elucidated. The aim of this cross-sectional study was to determine whether increasing OSA severity is associated with poorer endothelial function in patients with T2D.Methods140 patients with T2D and no overt CV disease underwent polysomnography, peripheral arterial tonometry, clinic blood pressure (BP) measurement, biological assessment for CV risk factors, daytime sleepiness and health related quality of life (HRQL) questionnaires. The following commonly used cut-offs for apnea-hypopnea index (AHI) were used to define 3 categories of disease severity: AHI < 15 (no OSA or mild OSA), 15 ≤ AHI < 30 (moderate OSA), and AHI ≥ 30 (severe OSA). The primary outcome was the reactive hyperemia index (RHI), a validated assessment of endothelial function.Results21.4% of patients had moderate OSA and 47.6% had severe OSA. Increasing OSA severity and nocturnal hypoxemia were not associated with a significant decrease in RHI. Endothelial dysfunction (RHI < 1.67) was found in 47.1, 44.4 and 39.2% of patients with no OSA or mild OSA, moderate OSA and severe OSA, respectively (p = 0.76). After adjustment for confounders including body mass index, increasing OSA severity was associated with higher systolic BP (p = 0.03), lower circulating levels of adiponectin (p = 0.0009), higher levels of sP-selectin (p = 0.03), lower scores in 3 domains of HRQL including energy/vitality (p = 0.02), role functioning (p = 0.01), and social functioning (p = 0.04).ConclusionsModerate to severe OSA is very common but has no impact on digital micro-vascular endothelial function in patients with T2D.

【 授权许可】

CC BY   
© The Author(s) 2017