Renal Damage And CPAP Curative Effect In Type2Diabetes Combined With OSAHS

Objectives:①To analyse the influence of obstructive sleep apnea-hypopnea syndrome(OSAHS) on renal damage in type2diabetes mellitus (T2DM).②To observe the changes ofrenal function in patients of T2DM combined with OSAHS before and after continuouspositive airway pressure (CPAP) treatment, and to observe the CPAP curative effect ondiabetic nephropathy (DN).Methods: The hospitalized patients with T2DM were screened for OSAHS. Portablesleep respiration monitor was used to detect apnea hypopnea index (AHI), oxygendesaturation index (ODI) and lowest oxygen saturation (LSaO2). All patients’ general clinicaldata, serum creatinine, urea nitrogen, cystatin C, hemoglobin A1C (HbA1c), fasting plasmaglucose,24-hour urine microalbumin and creatinine clearance rate were recorded andanalyzed. According to the diagnostic criteria, patients were divided into simple T2DM group(n=60), Mild OSAHS group (n=39) and moderate-to-severe OSAHS group (n=41), comparetheir clinical data of the3groups; the relations between renal damage indexs and OSAHSindexs were investigated by partial correlation analysis; according to whether they had DN ornot, the patients were divided into DN group (n=44) and non DN group (n=96), compare andanalyze their clinical data; influencing factors of DN were analyzed by multiple logisticregression analysis either.46patients of T2DM combined with OSAHS whose blood glucosecontrol is relatively good were treated with CPAP, to compar the indexes before and aftertreatment, and to observe the effect of CPAP on DN.Results: Compared with simply T2DM group, body mass index, serum cystatin C,prevalence of DN were significantly higher in moderate-to-severe OSAHS group (P<0.05). The24hour urine microalbumin were positively related with AHI(r=0.31) and ODI(r=0.42）(P<0.05), but had no significant correlation with LSaO2(P<0.05). The cystatin C werepositively related with AHI（r=0.44）and ODI(r=0.48）(P<0.05), and negatively related withLSaO2（r=﹣0.29）(P<0.05). Compared with the non DN patients, the age of the DN patientswere more older and their diabetes duration were longer (P<0.05), moreover, their HbA1c,fasting plasma glucose and ODI were significantly higher (P<0.05), there were no significantdifferences between the two groups in AHI, LSaO2and BMI (P＞0.05). Multivariate logisticregression analysis revealed that HbA1c, ODI and diabetes duration were independentlycorrelated with DN (P<0.05). After CPAP treatment, there was a decrease in fasting plasmaglucose, HbA1c,24hour urine microalbumin, cystatin C and serum creatinine(P<0.05),however, the BMI, serum urea nitrogen and creatinine clearance rate had no significantdifferences before and after CPAP treatment (P＞0.05); The total effective rate in13patientswith DN was84.6%, while87.5％and60.0％in early DN with OSAHS and clinical DNrespectively.Conclusions:①OSAHS aggravates renal damage in patients with T2DM.②Thefrequency of hypoxia is the main cause for OSAHS to aggravate renal damage in patients withT2DM.③CPAP treatment can improve the renal function in patients of T2DM combinedwith OSAHS.