The Risk Factors Analysis For Carotid Atherosclerosis In Patients With Sleep Apnea Syndrome Complicated With Type 2 Diabetes Mellitu

Background:Obstructive sleep apnea hypopnea syndrome is caused by recurrent upper respiratory tract obstruction during sleep due to obesity,abnormal anatomical structure or other pathological conditions,resulting in hypopnea or apnea.The main clinical manifestations are nocturnal snoring,repeated waking,daytime drowsiness,memory loss and other symptoms,which can be secondary to a variety of cardio-cerebrovascular and metabolic diseases.OSAHS and Type 2 diabetes mellitus often exist in the same individual from clinical findings,investigations indicate that diabetes can increase the risk of OSAHS,and to some extent OSAHS can also also lead to the occurrence and development of insulin resistance,disorder of glucose metabolism and even acute and chronic complications of diabetes.In clinical studies,there are few and different conclusions studies on blood glucose and blood lipids in patients with OSAHS complicated with T2DM,and studies on vitamin D levels have not been found.Atherosclerosis is a common peripheral vascular lesion in patients with T2DM,and carotid atherosclerosis is a kind of Atherosclerotic cardiovascular disease.Early detection of carotid atherosclerosis in patients with OSAHS complicated with T2DM is particularly important.However,there are few studies on the risk factors of carotid atherosclerosis in patients with OSAHS complicated with diabetes at present,and the conclusions are different.Under this background,the purpose of this study was to analyze the levels of blood glucose,blood lipids and vitamin D in patients with different degrees of OSAHS complicated with T2DM,and focus on the risk factors of carotid atherosclerosis in patients with OSAHS complicated with T2DM,in order to improve medical workers' understanding of patients with OSAHS complicated with T2DM,and to provide reference for the prevention and early diagnosis and treatment of carotid atherosclerosis in patients with T2DM complicated with OSAHS.Objective:1.To explore the difference of clinical characteristics between patients withOSAHS complicated with T2DM and diabetic patients without OSAHS.2.Focus on the risk factors of carotid atherosclerosis in patients with OSAHS and T2DM.Method:Selecting 134 patients with OSAHS complicated with T2DM,who were admitted to the Second Affiliated Hospital of Nanchang University from June 2019 to January 2020,then dividing patients into three subgroups according to the Apnea hypopnea index : 45 patients in mild OSAHS group(5?AHI?15),44 patients in moderate OSAHS group(15 <AHI?30)and 45 patients in severe OSAHS group(AHI> 30).Finally,49 patients with T2DM who have the AHI<5 were selected as the control group(diabetic patients without OSAHS group).Collect general information of all subjects,including age,gender,systolic blood pressure,diastolic blood pressure,history of hypertension,course of diabetes mellitus,measurement of height,weight,calculation of body mass index,and measurement of neck circumference and waist circumference with a tape measure.Drawing blood for examination of Fasting plasma glucose,glycosylated hemoglobin,2-hour postprandial blood glucose,total cholesterol,glycerin Triglycerides,high density lipoprotein cholesterol,low density lipoprotein cholesterol,and 25 Hydroxyvitamin D level.Ultrasound doctors in our hospital performed carotid artery color Doppler ultrasound on patients.ZG-SO1 A was used to monitor the sleep and breathing of patients.The indicators include apnea hypopnea index,lowest arterial oxygen saturation at night,and mean sleep oxygen saturation.All data were statistically analyzed by SPSS 25.0.Results:1.Comparison of clinical characteristics among groups:The number of male patients in severe OSAHS group was significantly more than that in control group.The body weight,BMI,neck circumference,waist circumference and systolic blood pressure in moderate and severe OSAHS group were higher than those in control group and mild OSAHS group.The diastolic blood pressure in moderate OSAHS group was higher than that in control group and mild OSAHS group.The number of hypertensive patients in moderate and severe OSAHSgroup was more than that in control group.There was no significant difference in blood glucose among the four groups.The TG of moderate and severe OSAHS group was higher than that in control group,but there was no significant difference in TC,HDL-C and LDL-C among the four groups.The serum 25(OH)D level in moderate and severe OSAHS group was significantly lower than that in control group,and the serum 25(OH)D level in severe OSAHS group was lower than that in mild OSAHS group.2.Differences in the number of carotid atherosclerosis among groups:The carotid intima-media thickness and the number of carotid atherosclerosis in moderate and severe OSAHS groups were higher than those in control group and mild OSAHS group.3.Spearman correlation analysis about risk factors of carotid atherosclerosis in patients with OSAHS complicated with T2DM:Carotid atherosclerosis in patients with T2DM complicated with OSAHS was positively correlated with age,body weight,BMI,neck circumference,waist circumference,systolic blood pressure,history of hypertension,TG and AHI,and negatively correlated with 25(OH)D,HDL-C,MSaO2 and LSaO2.4.Binary Logistic regression analysis about influencing factors of carotid atherosclerosis in patients with OSAHS complicated with T2DM:25(OH)D and HDL-C were protective factors of carotid atherosclerosis in patients with OSAHS complicated with T2DM,while age and AHI were risk factors.Conclusion:1.The neck circumference,waist circumference and the level of TG in OSAHS complicated with T2DM is higher than that in patients with simple diabetes.The level of vitamin D in patients with moderate and severe OSAHS complicated with diabetes mellitus was significantly lower than that in patients with simple diabetes mellitus.2.With the aggravation of the severity of OSAHS,CIMT is obviously thickened,and there are more patients with carotid atherosclerosis.3.Age,AHI,25(OH)D and HDL-C are the risk factors of carotid atherosclerosis in patients with OSAHS and T2DM.With the increase of age,the aggravation of OSAHS and the decrease of serum 25(OH)D and HDL-C,the risk ofcarotid atherosclerosis increase in patients with OSAHS complicated with T2DM.