Abstract：Objective To investigate the effect of obstructive sleep apnea hypopnea syndrome (OSAHS) on the progression of diabetic nephropathy in elderly type 2 diabetes mellitus (T2DM) patients. Methods A total of 145 T2DM patients admitted to Huaian First People’s Hospital Affiliated to Nanjing Medical University from February 2018 to March 2020 were selected as the study subjects. T2DM patients with nephropathy were statisticsed and they were divided into diabetic nephropathy group and simple diabetes group according to the status of T2DM patients with nephropathy. The clinical data of two groups were compared. The factors affecting the occurrence of T2DM nephropathy were analyzed by logistic multifactor regression. Results In this study, the incidence of diabetic nephropathy in 145 T2DM patients was 26.21%. The course of diabetes, standard deviation of blood glucose (SDBG), mean amplitude of glycemic excursions, mean absolute value of daytime blood glucose (MODD), urinary albumin, serum creatinine (Scr), and apnea hypoventilation index (AHI) in diabetic nephropathy group were higher than those in simple diabetic group (P ＜ 0.05). The estimated glomerular filtration rate (eGFR) and night minimum pulse oxygen saturation (LSPO2) were lower than those in the simple diabetic group (P ＜ 0.05). Logistic multivariate analysis showed that MODD, eGFR, AHI, and LSPO2 were all influencing factors of diabetic nephropathy in elderly T2DM patients (OR = 1.992, 0.826, 4.204, 0.753, P ＜ 0.05). Conclusion SDBG, MODD, AHI and LSPO2 are all influencing factors affecting the occurrence of diabetic nephropathy in elderly patients with T2DM. OSAHS can promote the progress of diabetic nephropathy in elderly patients with T2DM.
[1] Gottlieb DJ，Punjabi NM. Diagnosis and management of obstructive sleep apnea：a review [J]. JAMA，2020，323（14）： 1389-1400.
[2] Gulotta G，Iannella G，Vicini C，et al. Risk factors for obstructive sleep apnea syndrome in children： state of the art [J]. Int J Environ Res Public Health，2019，16（18）：3235.
[3] Toyama T，Neuen BL，Jun M，et al. Effect of SGLT2 inhibitors on cardiovascular，renal and safety outcomes in patients with type 2 diabetes mellitus and chronic kidney disease：a systematic review and meta-analysis [J]. Diabetes Obes Metab，2019，21（5）：1237-1250.
[4] Wanner C，Lachin JM，Inzucchi SE，et al. Empagliflozin and clinical outcomes in patients with type 2 diabetes mellitus，established cardiovascular disease，and chronic kidney disease [J]. Circulation，2018，137（2）：119-129.
[5] 朱育年，孔朝红，江健.阻塞性睡眠呼吸暂停低通气综合征合并2型糖尿病患者CXCL13，KIM-1，CTRP5，Klotho表达水平及其临床意义[J].临床与病理杂志，2020，40（3）：682-688.
[6] 李洪梅，韩旸，王凯亮.CPAP对2型糖尿病合并OSAHS患者的临床疗效观察[J].世界睡眠医学杂志，2019，6（1）：17-19.
[7] 中华医学会糖尿病学分会.中国2型糖尿病防治指南（2017年版）[J].中国实用内科杂志，2018，38（4）：34-86.
[8] 中华医学会内分泌学分会.中国成人糖尿病肾脏病临床诊断的专家共识[J].中华内分泌代谢杂志，2015，31（5）： 379-385.
[9] Muraki I，Wada H，Tanigawa T. Sleep apnea and type 2 diabetes [J]. J Diabetes Investig，2018，9（5）：991-997.
[10] 李惠平，何凌.睡眠呼吸暂停低通气综合征与老年2型糖尿病肾病的相关性[J].中国医师杂志，2020，22（11）：1654-1658.
[11] Abud R，Salgueiro M，Drake L，et al. Efficacy of continuous positive airway pressure（CPAP） preventing type 2 diabetes mellitus in patients with obstructive sleep apnea hypopnea syndrome（OSAHS） and insulin resistance：a systematic review and meta-analysis [J]. Sleep Med，2019， 62（8）：14-21.
[12] 钟丽艳.老年2型糖尿病合并OSAHS患者的临床特点研究[D].昆明：昆明医科大学，2019，32（6）：25-31.
[13] 李真真，付爱双，戈艳蕾，等.2型糖尿病伴OSAHS患者血清HCY，SAA水平与认知功能的关系研究[J].重庆医学，2019，48（5）：89-92.
[14] 白冰，赵文飞，吴毓敏.阻塞性睡眠呼吸暂停低通气综合征对2型糖尿病患者动态血糖及肾功能的影响[J].重庆医学，2019，48（11）：1897-1901.
[15] Gabryelska A，Karuga FF，Szmyd B，et al. HIF-1α as a mediator of insulin resistance，T2DM，and its complications： potential links with obstructive sleep apnea [J]. Front Physiol，2020，11（8）：1035.
[16] Dong M，Guo F，Zhou T，et al. Association of diabetic nephropathy with the severity of obstructive sleep apnea-hypopnea syndrome in patients with type 2 diabetes mellitus [J]. Endocr J，2020，67（5）：515-522.
[17] 姜菲，刘岩，任丽珏，等.阻塞性睡眠呼吸暂停综合征与2型糖尿病慢性并发症的相关性研究[J].中国实用内科杂志，2019，39（11）：57-60.
[18] 谢宇，刘聪辉.2型糖尿病伴OSAHS患者血清NPY，NGAL水平变化及其与早期认知功能损伤的关系[J].临床和实验医学杂志，2020，325（21）：53-56.
[19] 魏嘉洁，矫杰，周迎生.2型糖尿病合并阻塞性睡眠呼吸暂停综合征的临床特征及其危险因素[J].首都医科大学学报，2020，41（1）：35-39.
[20] Zhang J，Tian L，Guo L. Changes of aldosterone levels in patients with type 2 diabetes complicated by moderate to severe obstructive sleep apnea-hypopnea syndrome before and after treatment with continuous positive airway pressure [J]. J Int Med Res，2019，47（10）：4723-4733.
[21] 周密，龚艳琳，李伟，等.阻塞性睡眠呼吸暂停低通气综合征对2型糖尿病肾病的影响及血管内皮生长因子与2型糖尿病肾病的相关性分析[J].临床内科杂志，2019， 36（7）：456-459.
[22] 胡丽叶，王珏，朱旅云，等.2型糖尿病合并阻塞性睡眠呼吸暂停综合征患者血糖情况及早期动脉硬化的研究[J].临床内科杂志，2018，35（10）：706-707.
[23] Labarca G，Reyes T，Jorquera J，et al. CPAP in patients with obstructive sleep apnea and type 2 diabetes mellitus： Systematic review and meta-analysis [J]. Clin Respir J，2018，12（8）：2361-2368.
[24] Tang Y，Sun Q，Bai XY，et al. Effect of dapagliflozin on obstructive sleep apnea in patients with type 2 diabetes： a preliminary study [J]. Nutr Diabetes，2019，9（1）：32.
[25] 范克新，乔华.阻塞型睡眠呼吸暂停低通气综合征与糖尿病肾病关系的研究进展[J].国际呼吸杂志，2018，38（10）：787-790.
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