Obstructive sleep apnea hypopnea syndrome in patients with type 2 diabetes mellitus and its relationship with neurotransmitter levels in cerebral tissue

Abstract

Objective To evaluate the status of obstructive sleep apnea hypopnea syndrome (OSAHS) in patients with type 2 diabetes, and to investigate the association with neurotransmitter levels in cerebral tissue. Methods The status of OSAHS was evaluated using portable sleep apnea monitor in 328 patients with type 2 diabetes who was hospitalized from September 2012 to September 2014 in Department of Endocrinology, Shanghai East Hospital, of which brain proton magnetic resonance spectroscopy was performed in 132 patients to detect neurotransmitter levels in the left hippocampus and left brainstem area. Patients were divided into T2DM without OSAHS group (125 cases) and T2DM with OSAHS group (203 cases) according hypopnea index (AHI). Measurement data between two groups were compared by using t test, count data rate were compared by using χ2 test. Results The prevalence of OSAHS was 61.9% (203/328) in patients with type 2 diabetes mellitus. There were significant differences in age, body mass index (BMI), waist circumference, hip circumference, Cho/Cr level in the left hippocampus and Cho/NAA level in the left brainstem area and prevalence rate of hypertension in patients with OSAHS compared that with non–OSAHS (t=– 2.038,– 3.391,– 2.577,– 2.576, Z=– 1.923、– 2.06, χ2=5.746, all P<0.05). There were significant differences in diabetes duration, body mass index, prevalence rate of hypertension in patients with severe OSAHS compared that with mild OSAHS (t = – 2.074,– 3.923,χ2=4.524, all P< 0.05). Logistic regression analysis showed that age (OR1.03, 95% CI 1.01– 1.05, P<0.05), body mass index(OR=1.14, 95% CI 1.07– 1.23, P<0.05), NAA/Cr (OR=1.563,95% CI 1.02–2.438, P<0.05) and Cho/Cr level(OR=0.506,95% CI 0.263– 0.976, P<0.05) in the left hippocampus were independent risk factors of OSAHS. Conclusions There is higher prevalence of OSAHS in patients with type 2 diabetes. BMI and age are the risk factors of OSAHS. There are abnormal metabolic changes in neurotransmitter levels in the left hippocampus and left brainstem area in diabetic patients with OSAHS. Key words: Diabetes mellitus, type 2; Obstructive sleep apnea hypopnea syndrome; Hydrogen proton magnetic resonance spectroscopy; Neurotransmitter