| Objective:To observe the major adverse cardiovascular and cerebrovascular events（MACCE）and the risk of all-cause death of the adverse prognosis in elderly patients with obstructive sleep apnea syndrome（OSAS）compilcated with type 2 diabetes（T2DM）who had no history of cardio-cerebrovascular disease and were not treated with continuous positive airway pressure（CPAP）,so as to provide evidence for health management and early prevention of related diseases in elderly patients with OSAS comorbid T2DM.Methods:This study is based on a retrospective analysis of a multicenter,prospective,cohort study.From January 2015 to October 2017,the multicenter continuously recruited 1290 patients who first diagnosed with OSAS,over 60 years old with complete baseline indicators for follow-up.OSAS was defined by apnea hypopnea index（AHI）≥5 times/h recorded by overnight polysomnography（PSG）.The study collected demographic data,clinical history,laboratory indicators,sleep parameters and endpoint events during the follow-up period.According to the baseline T2DM exposure,OSAS patients were divided into T2DM group（n=258）and non-T2DM group（n=709）.The median follow-up period was 42 months.The follow-up endpoints were MACCE,all-cause death,a composite of all events,and MACCE component events of cardiovascular death,myocardial infarction（MI）,stroke,hospitalisation for unstable angina and heart failure.Kaplan-Meier survival curve and Cox proportional hazard regression model were used to evaluate the longitudinal impact of the risk of long-term end events in elderly patients with OSAS complicated with T2DM,and further subgroup analysis was used to eliminate the impact of homogeneity on the conclusions of the study.In addition,the multivariate adjusted Cox regression model of the cohort after matching is established by propensity score matching（PSM）analysis to verify the robustness of the research results.Results:1.Finally,967 elderly patients with OSAS were included in the analysis.Compared with the non-T2DM group,the T2DM group had older age,higher body mass index,higher proportion of male and severe OSAS,and the difference was statistically significant（P<0.05）.2.Within a median follow-up of 42 months,the incidences of MACCE,all-cause death,cardiovascular death,MI,hospitalized heart failure,stroke,hospitalization for unstable angina,and compound endpoint events were 11.47%,3.10%,1.24%,2.59%,0.72%,4.24%,4.14%and 13.13%,respectively.Among them,the incidence of MACCE and all-cause death in T2DM group and non-T2DM group was 18.99%,8.74%and5.43%,2.26%respectively,and the difference was statistically significant（P<0.05,P<0.01）.The Kaplan-Meier survival curve showed that there were significant differences in the cumulative risk of MACCE,all-cause death,a composite of all events,hospitalization for unstable angina and stroke between the T2DM group and the non-T2DM group(PLog-rank<0.01).The cumulative risk in the T2DM group was higher than that in the non-T2DM group.However,there was no significant difference in the cumulative risk of heart failure,cardiovascular death and MI between the T2DM group and the non-T2DM group(PLog-rank>0.05).3.In minimally adjusted,partially adjusted,and fully adjusted Cox proportional hazards regression models,the presence of baseline T2DM was associated with higher MACCE,all-cause death,composite end point events,hospitalization for unstable angina,and stroke events in older OSAS patients（P<0.05,P<0.01）.The hazard ratios of the above-mentioned end-point events showed a decreasing trend with the increase of the number of adjustment variables.After adjusted for potential confounding variables,the multivariate Cox regression analysis（fully adjusted）still founded that a significant differences in the risk of MACCE,all-cause death,composite endpoint events,hospitalization for unstable angina,and stroke events between T2DM group and non-T2DM group among OSAS patients（P<0.05,P<0.01）.T2DM group were 1.79times（HR=1.79,95%CI:1.20 to 2.67）,2.22 times（HR=2.22,95%CI:1.02 to 4.83）,1.67times（HR=1.67,95%CI:1.08 to 2.57）,2.13 times（HR=2.13,95%CI:1.08 to 4.19）,and2.98 times（HR=2.98,95%CI:1.59 to 5.60）compared with those in the non-T2DM group OSAS patients,respectively.However,compared with patients in the non-T2DM group,there was no statistically significant in the risk of MI,cardiovascular death and hospitalization for heart failure in the MACCE components of the OSAS patients in the T2DM group（P>0.05）.4.Sub-analysis showed that patients with OSAS in T2DM group with age≥70 years,male,overweight and obesity and AHI≥15 times/h had higher risk of MACCE（all P<0.05）.Patients with OSAS in T2DM group with age≥70 years,female,overweight and obesity and AHI≥15 times/h have higher risk of all-cause death（all P<0.05）.5.The results of PSM analysis showed that there were significant differences in MACCE,compound end point events,and stroke risk between T2DM group and non-T2DM group（P<0.05）.T2DM group were 1.78 times（HR=1.78,95%CI:1.02 to3.11）,1.75 times（HR=1.75,95%CI:1.06 to 2.90）and 2.45 times（HR=2.45,95%CI:1.05 to 5.69）higher than that in non-T2DM group,while the HR value after MACCE and stroke matching was slightly lower than that before matching.In addition,the results of a propensity score matching analysis showed that comorbid T2DM increased the risk of unstable angina pectoris and all-cause death in elderly patients with OSAS,but there was no significant difference between groups（P>0.05）.Conclusion:With T2DM is an independent risk factor for the risk of MACCE,all-cause death,a composite of all events,and MACCE component events of hospitalisation for unstable angina and stroke in elderly OSAS patients.Elderly patients with T2DM are a potential clinical high-risk population.Screening early the latent complications and developing relevant prevention strategies in order to reduce the risk of poor prognosis in this population. |
