Obstructive Sleep Apnea And Type 2 Diabetes: Bibliometric Analysis And Bidirectional Mendelian Randomization Study

【Objective】Despite that a massive literature related to obstructive sleep apnea(OSA)and type2 diabetes(T2D)is published every year,systematic analyses of the pertinent literature and gene-level association studies are still lacking.Therefore,this research first conducted a bibliometric analysis of the relevant literature on OSA and T2 D,and evaluated the current situation,hot spots and development trends in this research field,hoping to provide insights into further research directions.Then,the causal relationship between OSA and T2 D was investigated at the genetic level using bidirectional Mendelian randomization(MR).【Methods】Bibliometric analysis: all documents in English themed on "obstructive sleep apnea" and "type 2 diabetes" were retrieved in the Web of Science(WOS)core database with publication up to December 31,2022.The document type was selected as " Article" or "Review Article",and the final search results were preserved in "text" format.Using software such as R 4.2.1,VOSviewer 1.6.18 and Cite Space 6.1.R6,statistical analysis was performed on the annual publication volume,country,institution,author,journal,and keywords of associated literature on OSA and T2 D,and a visual scientific map was created.Bidirectional MR study: OSA-related genetic data was from the Finn Gen Biobank(case group=16,761,control group=201,194)in the Genome-wide association study(GWAS).T2D-related genetic data was obtained from a large meta-analysis of GWAS(case group=62,892,control group=596,424).First,based on the GWAS database of OSA,single-nucleotide polymorphisms(SNPs)were screened as instrumental variables(IVs)for forward MR analysis,and F value statistics were utilized to assess the strength of IVs.Various MR methods were used for analysis,with inverse variance weighted(IVW)method as the gold standard.Subsequently,sensitivity analysis was performed to evaluate heterogeneity and horizontal pleiotropic effects.The reverse MR analysis was then conducted using the same manner with IVs screened from the T2 D GWAS database【Results】Bibliometric analysis: a total of 1,000 pieces of literature in English on OSA and T2 D were included.The initial study in this area was released in 1999.The interest in this field’s study has grown since 2006 and reached its peak in 2020.The United States is the most frequent and the earliest country to participate in international cooperation in this research field,whereas China is relatively late in doing so.The United States also ranks first in terms of related papers on OSA and T2 D and citations,while China ranks second in terms of published papers.The University of Pittsburgh published the most relevant papers and collaborated with other institutions the most frequently among the universities that published related literature on OSA and T2 D.The University of Pennsylvania was the first organization to collaborate in this area.PUNJABI NM,who has published the most related papers and received the most citations in the field of OSA and T2 D research,is the author with the greatest authority;The most cooperative author in this field is WADDEN TA,who has established the most extensive network of collaborations with FOSTER GD,THOMAS GN and NEWMAN AB.The research on OSA and T2 D is of greater interest to journals devoted to obesity and sleep,with OBESITY SURGERY having the most articles.The top journal in the field of diabetes,DIABETES CARE,is where the majority of the most-cited work in OSA and T2 D research was published,the research content is a cross-sectional survey of OSA in obese T2 D patients.The most frequent keyword in OSA and T2D-related literature was obstructive sleep apnea,followed by insulin resistance and positive airway pressure.The keyword burst graph suggests that C-reactive protein was both the earliest and the topic with the greatest duration of study interest in the fields of OSA and T2 D.Over the years,obese patients have been the theme with the highest burst strength.Over the past five years,continuous positive airway pressure,risk,severity,fatality,complications,and index have been the most prominent research areas for OSA and T2 D.Bidirectional MR study: in forward MR,3 SNPs were screened out as IVs,which were strong instrumental variables(F = 20.543).IVW method suggested that OSA predicted by genes was a notable risk factor for T2D(OR = 2.016;95% CI,1.185-3.429;P = 9.671×10-3),the results had heterogeneity(P = 1.808×10-11)and had no horizontal pleiotropy(P = 0.477).In the reverse MR analysis,114 SNPs were screened out as IVs,which were strong instrumental variables(F = 30.117).IVW method indicated that there was no significant correlation between T2 D predicted by genes and the risk of OSA occurrence(OR = 1.030;95% CI,0.980-1.083;P = 0.239),the results had heterogeneity(P = 1.729×10-7)and had no horizontal pleiotropy(P = 0.349).【Conclusion】Bibliometric analysis: since the initial publications of related OSA and T2 D investigations in 1999,interest in the field has grown steadily.The most authoritative country in this field is the United States,the most authoritative institution is the University of Pittsburgh,and the most authoritative author is PUNJABI NM.Obesity and sleep journals are interested in the field of OSA and T2 D research,and the journal with the largest publication of related articles is OBESITY SURGERY.Obese patients have been the focus of related OSA and T2 D studies over the years,whereas persistent positive airway pressure,risk,severity,death,complications,and indices have been the hotspots in the previous 5 years.Bidirectional MR study: The IVW method confirmed that OSA predicted by gene was a risk factor for T2 D,and the risk of T2 D in OSA predicted by gene was 2.016 times that of non-OSA.The IVW method suggested that there was no remarkable association between T2 D predicted by genes and OSA.