Clinical Characteristics And Efficacy Analysis Of Nasal CPAP And Aerobic Exercise Of Different Intensity In Patients With Obstructive Sleep Apnea Hypopnea Syndrome Associated Type 2 Diabetes Mellitus

Objective To compare the clinical characteristics of Type 2 Diabetes Mellitus(T2DM)between Obstructive Sleep Apnea Hypopnea Syndrome(OSAHS)with T2DM.To explore the therapeutic efficacy of nasal Continuous Positive Airway Pressure(CPAP)and(or)aerobic exercise of different intensity in patients with OSAHS associated T2DM.Methods The 436 patients of T2DM,with a mean age of(70.06±9.97)years,the Fourth Rehabilitation Hospital of Shanghai and the Second Affiliated Hospital of Soochow University from January 2014 to December 2018 were enrolled prospectively.All patients were tested by polysomnography(PSG).Laboratory-based polysomnographic variables[including apnea hypopnea index(AHI),oxygen desaturation index and microarousal index(MAI),etc.],and glycolipid metabolism,Epworth Sleepiness Scale(ESS),Body Mass Index(BMI),Mini Mental State examination(MMSE)were collected for all participants.There were 211 T2DM patients with OSAHS and 225 T2DM patients in this study.There were divided into two groups based on whether use nasal CPAP therapy in T2DM patients with OSAHS:96 cases in nasal CPAP+aerobic exercise group and 115 cases in aerobic exercise group.Subsequently,patients in nasal CPAP+aerobic exercise group were randomly divided into two subgroups:Group-CPAP+moderate intensity aerobic exercise and Group-CPAP+low intensity aerobic exercise(50 and 46 cases respectively),and patients in aerobic exercise group were randomly divided into two subgroups too:Group-moderate intensity aerobic exercise and Group-low intensity aerobic exercise(55 and 60 cases respectively).Finally,a total of 172 T2DM patients with OSAHS patients including 88 males and 84 females whose mean age was 69.56±9.54 years,were completed nasal CPAP and(or)aerobic exercise of different intensity for 20 weeks.The therapeutic efficacy of PSG parameters,glycolipid metabolism,6 minutes walking distance(6MWD),and rate of perceived exertion(RPE)were compared between each group before and after treatment.Results1.Clinical characteristics between T2DM group and OSAHS with T2DM group were compared.There were significant differences in underlying diseases,BMI,AHI,MMSE,ESS and glucolipid metabolism(P<0.05),however,there were no significant differences in gender,age and high-density lipoprotein(HDL-CH)(P>0.05).The OSAHS with T2DM group was characterized by high proportion of underlying diseases,the ESS(9.20±4.84),AHI(19.04±7.26),fasting blood-glucose(FBG)(6.89±2.15),fasting insulin(9.68±3.79),glycosylated hemoglobin(HbA1c)(7.50±0.94),HOMA-IR(3.20±2.01),total cholesterol(TCh)(3.73±0.89),triglyceride(TG)[1.13(0.94-1.52)],LDL-CH(4.00±0.64)and lipoprotein(a)(Lp(a))[208(91-282)]were significantly higher than the T2DM group,but MMSE(16.33±5.84)was significantly lower than the T2DM group.2.Pre-and post-intervention,the parameters of nasal CPAP+aerobic exercise group and aerobic exercise group were compared with themselves and intergroup.The parameters of PSG,BMI(25.95±3.29 vs.23.59±2,59),exercise tolerance[RPE(16.21±1.23 vs.11.63±2.52),6min walking distance(368.53±54.51 vs.425.29±68.48)]and glucolipid metabolism,including FBG(7.17± 2.24 vs.5.92±1.40),HbAlc(7.51±1.06 vs.6.47±0.60),fasting insulin(9.80±4.21 vs.5.66±2.52),HOMA-IR(3.32±2.06 vs.1.61±1.07),TCh(3.91±0.85 vs.3.35±0.86)and LDL-CH(4.08±0.58 vs.3.03±0.79)were significantly improved by themselves in nasal CPAP+aerobic exercise group(P<0.05).The parameters of BMI,6MWD and RPE were significantly improved by themselves in aerobic exercise group,and parameters of glucolipid metabolism and PSG were significantly improved partly(P<0.05).Compared with aerobic exercise group,the parameters of PSG,glucolipid metabolism and exercise tolerance were significantly improved in nasal CPAP+aerobic exercise group,but BMI(P=0.741)and TG were have no significant differences between 2 groups.3.Pre-and post-intervention,the parameters of Group-CPAP+moderate intensity aerobic exercise and Group-CPAP+low intensity aerobic exercise were compared with themselves and intergroup.The parameters of PSG,BMI(25.48±3.12 vs.23.82±2.52),exercise tolerance[RPE(16.22±1.21 vs.10.51±2.42),6MWD(372.59±58.90 vs.447.32±73.41)]and glucolipid metabolism,including FBG(7.51±2.27 vs.5.69±1.14),HbA1c(7.61±1.09 vs.6.35±0.50),HOMA-IR(3.40±1.70 vs.1.31±0.93),TCh(4.04±0.92 vs.3.23±0.75)and LDL-CH(4.20±0.68vs.2.62±0.75)were significantly improved by themselves in Group-CPAP+moderate intensity aerobic exercise(P<0.01).The BMI,6MWD and RPE were significantly improved by themselves in Group-CPAP+low intensity aerobic exercise(P<0.01),and parameters of glucolipid metabolism and PSG were significantly improved partly(P<0.05).Compared with Group-CPAP+low intensity aerobic exercise,the parameters of glucolipid metabolism including fasting insulin,2h postprandial insulin,HOMA-IR,HDL-CH,LDL-CH,and Lp(a)and exercise tolerance were significantly improved in Group-CPAP+moderate intensity aerobic exercise,but BMI,FBG,2h postprandial blood glucose,HbAlc,TCh,TG and PSG were have no significant differences between 2 groups(P>0.05).4.Pre-and post-intervention,the parameters of Group-moderate intensity aerobic exercise and Group-low intensity aerobic exercise were compared with themselves and intergroup.The parameters of PSG,BMI(25.02±3.42 vs.23.13±2.34),exercise tolerance[RPE(16.38±1.75 vs.12.49±1.47),6MWD(378.49±67.12 vs.414.62±63.09)]and glucolipid metabolism,including FBG(6.68±2.13 vs.5.92±1.75),HbA1c(7.58±0.88 vs.6.73±0.67),HOMA-IR(3.23±1.99 vs.2.24±1.43),TCh(3.61±0.98 vs.3.40±0.67)and LDL-CH(3.94±0.74 vs.2.87±0.87)were significantly improved by themselves in Group-moderate intensity aerobic exercise(P<0.05).The PSG,BMI,HbAlc,6MWD and RPE were significantly improved by themselves in Group-low intensity aerobic exercise(P<0.05).Compared with Group-low intensity aerobic exercise,the parameters of AHI,glucolipid metabolism and exercise tolerance were significantly improved in Groupmoderate intensity aerobic exercise,but LSpO2 and TS90 were significantly lower(P>0.05).There were no significant differences between 2 groups in MAI,sleep stage and 6MWD.Conclusion1.OSAHS and T2DM interact with each other.The OSAHS patients with T2DM were characterized by higher BMI,have more complications of cardiovascular and cerebrovascular and more prone to glucolipid metabolism disorder,cognitive decline and daytime sleepiness.2.Nasal CPAP combined with aerobic exercise can effectively improve the sleep,glucolipid metabolism,insulin resistance and exercise tolerance in patients with OSAHS associated T2DM.3.Nasal CPAP combined with moderate intensity aerobic exercise has the best effect in serum insulin,HOMA-IR,HDL-CH,LDL-CH,Lp(a),6MWD and RPE on OSAHS patients with T2DM.