Abstract
Background Obstructive sleep apnea (OSA) was highly prevalent in patients with type 2 diabetes (T2D). Cathepsin S (CTSS), a cysteine protease, is involved in the inflammatory activity in T2D and hypoxia conditions. The aim of the study was to evaluate whether CTSS could be involved in the inflammatory reaction of OSA in patients with T2D. Methods We included 158 participants in this study matched for age, gender, and body mass index in 4 groups (control, non-OSA&T2D, OSA&non-T2D, and OSA&T2D). After overnight polysomnography, we collected the clinical data including anthropometrical characteristics, blood pressure, and fasting blood samples in the morning. Plasma CTSS concentration was evaluated using the human Magnetic Luminex Assay. Results Compared with the control group, both the non-OSA&T2D group and the OSA&non-T2D group showed higher CTSS levels. Plasma CTSS expression was significantly increased in subjects with OSA&T2D compared to subjects with non-OSA&T2D. The OSA&T2D group had higher CTSS levels than the OSA&non-T2D group, but there were no statistically significant differences. Plasma CTSS levels showed significant correlation with the apnea-hypopnea index (AHI) (r = 0.559, P < 0.001) and plasma fasting blood glucose (r = 0.427, P < 0.001). After adjusting confounding factors, plasma CTSS levels were independently associated with the AHI (Beta: 0.386, 95% confidence intervals (CI): 21.988 to 57.781; P < 0.001). Furthermore, we confirmed the higher pinpoint accuracy of plasma CTSS in the diagnosis of OSA (area under the curve: 0.868). Conclusions Plasma CTSS expression was significantly elevated in the OSA&T2D group and was independently associated with the AHI; it could be a biomarker with a positive diagnostic value on diagnosing OSA among patients with T2D.
Highlights
Obstructive sleep apnea (OSA) is a common disease that is characterized by repetitive collapse of the upper airway during sleep resulting in snoring, sleep disruption, nocturnal chronic intermittent hypoxia (CIH), and oxidative stress, which cause endothelial dysfunction and inflammatory reaction [1,2,3]
Participants were divided into four groups of control, non-OSA&type 2 diabetes (T2D), OSA&non-T2D, and OSA&T2D based on the FBG and apnea-hypopnea index (AHI) values
Compared with the control group, higher levels of the diastolic blood pressure, Epworth Sleepiness Scale (ESS) score, AHI, percentage of cumulative time with oxygen saturation below 90% (CT90), and arousal index were observed in the OSA&non-T2D group
Summary
Obstructive sleep apnea (OSA) is a common disease that is characterized by repetitive collapse of the upper airway during sleep resulting in snoring, sleep disruption, nocturnal chronic intermittent hypoxia (CIH), and oxidative stress, which cause endothelial dysfunction and inflammatory reaction [1,2,3]. Multiple epidemiological studies showed that around 50%-90% of patients with type 2 diabetes (T2D) have OSA; screening for OSA could be crucial for patients with T2D [8,9,10]. The aim of the study was to evaluate whether CTSS could be involved in the inflammatory reaction of OSA in patients with T2D. Compared with the control group, both the non-OSA&T2D group and the OSA&non-T2D group showed higher CTSS levels. Plasma CTSS levels showed significant correlation with the apnea-hypopnea index (AHI) (r = 0:559, P < 0:001) and plasma fasting blood glucose (r = 0:427, P < 0:001). Plasma CTSS expression was significantly elevated in the OSA&T2D group and was independently associated with the AHI; it could be a biomarker with a positive diagnostic value on diagnosing OSA among patients with T2D
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