中青年2型糖尿病合并阻塞性睡眠呼吸暂停低通气综合征患者认知功能特点及其影响因素

doi:10.3969/j.issn.1004-583X.2023.03.003

摘要/Abstract

摘要：

目的探讨中青年2型糖尿病(type 2 diabetes mellitus,T2DM)合并阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome, OSAHS)患者认知功能特点及其影响因素。方法选择2020年1月至2021年12月在苏州大学附属第三医院内分泌代谢科住院治疗的中青年T2DM合并OSAHS患者364例。根据中文版Addenbrooke认知评估量表Ⅲ(ACE-Ⅲ)分为认知功能障碍(cognitive impairment,CI)组( $n$ =187)和认知正常(normality cognitive,NC)组( $n$ =177)。比较两组临床资料,采用多因素Logistic回归分析筛选中青年T2DM合并OSAHS患者CI的独立危险因素,采用两因素方差分析比较不同体重指数(body mass index,BMI)和睡眠呼吸暂停低通气指数(apnea hypopnea index,AHI)对ACE-Ⅲ评分的影响。结果 364例患者中存在CI 187例(51.4%),CI组ACE-Ⅲ评分总分及5个认知维度评分均低于NC组( $P$ <0.05)。多因素Logistic回归分析显示,受教育年限、AHI、BMI和氧减指数是患者CI的独立危险因素(均 $P$ <0.05)。无论AHI如何,不同BMI组间ACE-Ⅲ评分差异均有统计学意义( $F$ =9.732, $P$ =0.000),随着BMI的增加,不同AHI患者ACE-Ⅲ评分均逐渐下降,但BMI和AHI对ACE-Ⅲ评分的影响交互效应不明显( $F$ =1.198, $P$ =0.311)。结论中青年T2DM合并OSAHS患者CI发生率高,BMI、AHI、氧减指数和受教育年限可能是该人群发生CI的危险因素。

关键词: 糖尿病,2型, 阻塞性睡眠呼吸暂停低通气综合征, 认知

Abstract:

Objective To explore the characteristics of cognitive function and corresponding factors in young and middle-aged patients with type 2 diabetes mellitus (T2DM) with obstructive sleep apnea hypopnea syndrome (OSAHS).Methods A total of 364 young and middle-aged T2DM patients with OSAHS hospitalized in the Endocrine Metabolism Department of the Third Affiliated Hospital of Soochow University from January 2020 to December 2021 were enrolled, and the patients were allocated to the cognitive impairment (CI) group ( $n$ =187) and normal cognitive (NC) group ( $n$ =177) based on Addenbrooke’s Cognitive Examination III (ACE-III) in Chinese version. The clinical data of the two groups were compared. Multivariate Logistic regression analysis was applied to explore the independent factors of cognitive dysfunction in middle-aged and young T2DM patients with OSAHS. Two-way ANOVA of body mass indexes (BMI) and apnea hypopnea index (AHI) on ACE-Ⅲ scores were performed. Results The 187 (51.4%) patients had CI. The total score of ACE -Ⅲ and five cognitive dimensions in CI group were lower than those in NC group ( $P$ <0.05). Multivariate Logistic regression analysis showed that education years, AHI, BMI and oxygen desaturation index were independent risk factors for CI (all $P$ <0.05). The ACE-Ⅲ scores difference between different BMI groups were statistically significant regardless of the AHI ( $F$ =9.732, $P$ =0.000). ACE-Ⅲ scores of patients with different AHI decreased gradually increase in BMI, and the interaction effects of BMI and AHI on ACE-Ⅲ score were insignificant ( $F$ =1.198, $P$ =0.311). Conclusion The incidence of CI in middle-aged and young patients with T2DM and OSAHS is higher, BMI, AHI, oxygen desaturation index, as well as education years may be risk factors for CI in the population.

Key words: diabetes mellitus, type 2, obstructive sleep apnea hypopnea syndrome, cognition

中图分类号:

R587.1

杨旻星, 孙璐, 叶赟, 徐文东, 黄小琳, 张海云, 徐英蕾. 中青年2型糖尿病合并阻塞性睡眠呼吸暂停低通气综合征患者认知功能特点及其影响因素[J]. 临床荟萃, 2023, 38(3): 216-220.

Yang Minxing, Sun Lu, Ye Yun, Xu Wendong, Huang Xiaolin, Zhang Haiyun, Xu Yinglei. Characteristics of cognitive function and corresponding factors in young and middle-aged patients with type 2 diabetes with obstructive sleep apnea hypopnea syndrome[J]. Clinical Focus, 2023, 38(3): 216-220.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.03.003

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I3/216

图/表 4

表1 两组ACE-Ⅲ总分及各维度比较(分, x -±s)

Tab.1 Comparison of the total score and dimensions of ACE-Ⅲ between the two groups (score, x -±s)

组别	例数	认知总分	记忆力	语言	语言流利性	注意和定向	视空间
NC组	177	92.12±2.73	22.51±1.72	22.54±1.78	13.75±0.48	17.51±0.92	15.81±0.47
CI组	187	78.46±7.65	15.40±3.81	17.02±3.30	13.28±0.98	17.16±1.50	15.61±0.94
$t$ 值		22.925	23.130	20.047	5.906	2.728	2.493
$P$ 值		0.001	0.001	0.001	0.001	0.007	0.013

表1 两组ACE-Ⅲ总分及各维度比较(分, x -±s)

Tab.1 Comparison of the total score and dimensions of ACE-Ⅲ between the two groups (score, x -±s)

组别	例数	认知总分	记忆力	语言	语言流利性	注意和定向	视空间
NC组	177	92.12±2.73	22.51±1.72	22.54±1.78	13.75±0.48	17.51±0.92	15.81±0.47
CI组	187	78.46±7.65	15.40±3.81	17.02±3.30	13.28±0.98	17.16±1.50	15.61±0.94
$t$ 值		22.925	23.130	20.047	5.906	2.728	2.493
$P$ 值		0.001	0.001	0.001	0.001	0.007	0.013

表2 两组一般资料、糖脂代谢指标、PSG监测和相关量表评分比较

Tab.2 Comparison of general information, PSG monitoring, and related scale scores between the two groups

组别		例数		年龄 (年)			BMI (kg/m²)		男 [例(%)]			吸烟史 [例(%)]			过量饮酒 [例(%)]	受教育年限 (年)		糖尿病病程 (年)			收缩压 (mmHg)
NC组		177		43.93±10.60			23.48±2.52		140(79.1)			35(19.8)			48(27.1)	11.58±3.36		4.56±5.49			134.23±16.43
CI组		187		45.81±10.18			25.66±2.62		139(74.3)			43(23.0)			42(22.5)	9.19±2.86		4.53±5.54			137.27±16.55
$t$ 值				-1.726			-8.048		1.153			0.560			1.060	7.340		0.047			-1.759
$P$ 值				0.085			0.000		0.283			0.454			0.303	0.002		0.963			0.079
组别			舒张压 (mmHg)		FPG (mmol/L)			2 hPG (mmol/ L)			HbA₁c (%)			TC (mmol/L)		TG (mmol/L)			HDL-C (mmol/L)			LDL-C (mmol/L)
NC组			84.56±11.14		8.83±2.87			13.20±5.02			9.58±2.35			4.76±1.28		1.92±1.11			1.08±0.70			2.76±1.08
CI组			85.66±10.46		8.64±2.46			13.20±4.69			9.45±2.33			5.33±1.54		2.06±1.16			1.08±0.71			2.87±1.00
$t$ 值			-0.965		0.694			0.001			0.532			-3.848		-1.176			-0.046			-1.034
$P$ 值			0.335		0.490			0.999			0.595			0.000		0.240			0.964			0.302
组别	ESS评分 (分)					PSQI评分 (分)				AHI (次/h)			OAI (次/h)				夜间LSaO₂ (%)			氧减指数 (次/h)
NC组	6.50±3.89					4.50±3.32				12.25±4.53			4.57±4.35				81.05±9.04			19.05±18.25
CI组	6.56±4.36					4.65±3.101				17.24±8.10			7.32±10.82				79.03±9.94			33.74±21.64
$t$ 值	-0.123					-0.444				-6.921			-3.148				2.029			-6.982
$P$ 值	0.902					0.658				0.000			0.002				0.043			0.000

表2 两组一般资料、糖脂代谢指标、PSG监测和相关量表评分比较

Tab.2 Comparison of general information, PSG monitoring, and related scale scores between the two groups

组别		例数		年龄 (年)			BMI (kg/m²)		男 [例(%)]			吸烟史 [例(%)]			过量饮酒 [例(%)]	受教育年限 (年)		糖尿病病程 (年)			收缩压 (mmHg)
NC组		177		43.93±10.60			23.48±2.52		140(79.1)			35(19.8)			48(27.1)	11.58±3.36		4.56±5.49			134.23±16.43
CI组		187		45.81±10.18			25.66±2.62		139(74.3)			43(23.0)			42(22.5)	9.19±2.86		4.53±5.54			137.27±16.55
$t$ 值				-1.726			-8.048		1.153			0.560			1.060	7.340		0.047			-1.759
$P$ 值				0.085			0.000		0.283			0.454			0.303	0.002		0.963			0.079
组别			舒张压 (mmHg)		FPG (mmol/L)			2 hPG (mmol/ L)			HbA₁c (%)			TC (mmol/L)		TG (mmol/L)			HDL-C (mmol/L)			LDL-C (mmol/L)
NC组			84.56±11.14		8.83±2.87			13.20±5.02			9.58±2.35			4.76±1.28		1.92±1.11			1.08±0.70			2.76±1.08
CI组			85.66±10.46		8.64±2.46			13.20±4.69			9.45±2.33			5.33±1.54		2.06±1.16			1.08±0.71			2.87±1.00
$t$ 值			-0.965		0.694			0.001			0.532			-3.848		-1.176			-0.046			-1.034
$P$ 值			0.335		0.490			0.999			0.595			0.000		0.240			0.964			0.302
组别	ESS评分 (分)					PSQI评分 (分)				AHI (次/h)			OAI (次/h)				夜间LSaO₂ (%)			氧减指数 (次/h)
NC组	6.50±3.89					4.50±3.32				12.25±4.53			4.57±4.35				81.05±9.04			19.05±18.25
CI组	6.56±4.36					4.65±3.101				17.24±8.10			7.32±10.82				79.03±9.94			33.74±21.64
$t$ 值	-0.123					-0.444				-6.921			-3.148				2.029			-6.982
$P$ 值	0.902					0.658				0.000			0.002				0.043			0.000

表3 中青年T2DM合并OSAHS患者CI影响因素的多因素Logistic回归分析

Tab.3 Multivariate Logistic regression analysis for cognitive impairment in young and middle-aged T2DM patients with OSAHS

因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
常量	-8.559	2.100	16.609	0.013	0.000	-	-
受教育年限	-0.269	0.048	31.996	0.006	0.764	0.696	0.839
AHI	0.136	0.028	23.272	0.000	1.146	1.084	1.211
BMI	0.325	0.056	33.478	0.000	1.384	1.240	1.545
氧减指数	0.031	0.007	17.539	0.025	1.032	1.017	1.047

表3 中青年T2DM合并OSAHS患者CI影响因素的多因素Logistic回归分析

Tab.3 Multivariate Logistic regression analysis for cognitive impairment in young and middle-aged T2DM patients with OSAHS

因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
常量	-8.559	2.100	16.609	0.013	0.000	-	-
受教育年限	-0.269	0.048	31.996	0.006	0.764	0.696	0.839
AHI	0.136	0.028	23.272	0.000	1.146	1.084	1.211
BMI	0.325	0.056	33.478	0.000	1.384	1.240	1.545
氧减指数	0.031	0.007	17.539	0.025	1.032	1.017	1.047

表4 BMI、AHI对ACE-Ⅲ评分的两因素方差分析(分, x -±s)

Tab.4 Two-factor ANOVA of BMI and AHI on ACE-Ⅲ score (score, x -±s)

AHI	BMI			合计	AHI主效应		BMI主效应		AHI*BMI交互效应
AHI	正常体重组	超重组	肥胖组	合计	$F$ 值	$P$ 值	$F$ 值	$P$ 值	$F$ 值	$P$ 值
轻度(5≤AHI<15次/h)	89.79±7.19	86.98±7.96	80.46±7.36	87.79±7.91	11.441	0.000	9.732	0.000	1.198	0.311
中度(15≤AHI<30次/h)	84.27±10.01	80.17±8.09	79.15±7.88	81.13±8.74
重度(AHI≥30次/h)	83.44±10.42	75.17±7.87	76.00±7.48	78.59±9.39
合计	88.16±8.45	83.92±8.81	79.23±7.50	85.11±8.96

表4 BMI、AHI对ACE-Ⅲ评分的两因素方差分析(分, x -±s)

Tab.4 Two-factor ANOVA of BMI and AHI on ACE-Ⅲ score (score, x -±s)

AHI	BMI			合计	AHI主效应		BMI主效应		AHI*BMI交互效应
AHI	正常体重组	超重组	肥胖组	合计	$F$ 值	$P$ 值	$F$ 值	$P$ 值	$F$ 值	$P$ 值
轻度(5≤AHI<15次/h)	89.79±7.19	86.98±7.96	80.46±7.36	87.79±7.91	11.441	0.000	9.732	0.000	1.198	0.311
中度(15≤AHI<30次/h)	84.27±10.01	80.17±8.09	79.15±7.88	81.13±8.74
重度(AHI≥30次/h)	83.44±10.42	75.17±7.87	76.00±7.48	78.59±9.39
合计	88.16±8.45	83.92±8.81	79.23±7.50	85.11±8.96

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