Characteristics of cognitive function and corresponding factors in young and middle-aged patients with type 2 diabetes with obstructive sleep apnea hypopnea syndrome

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

Abstract

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

CLC Number:

R587.1

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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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.03.003

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

Figures/Tables 4

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

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

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

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

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

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

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

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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