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Associations of apnea hypopnea index and educational attainments with microvascular complications in patients with T2DM

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Abstract

Purpose

The relationship between obstructive sleep apnea (OSA) and diabetic microvascular complications (DMC) are controversial. Whether low education is associated with increased risk of DMC independently of poor lifestyles are currently unknown. The aim of this study is to explore the independent associations of different PSG index and educational attainment with risks of DR, DKD, and DPN.

Methods

A cross-sectional study of 330 patients with T2DM who underwent overnight polysomnography (PSG) tests. Multivariable logistic regression analysis was performed to determine the associations of PSG index and educational attainments with DR, DKD, and DPN.

Results

The prevalence rates of DMC were 30.6% for DR, 24.9% for DKD, and 64.6% for DPN. All PSG index (AHI, REM-AHI, NREM-AHI, the severity of OSAS, ODI, MAI, and lowest SaO2) were not significantly associated with risks of DR, DKD, or DPN with adjustment for potential confounding factors. Subjects with increasing educational attainments showed significantly decreased prevalence rates of DR (42.6, 27.3, and 21.3%, p = 0.005), DKD (31.7, 25.3, and 14.7%, p = 0.035) and DPN (74.3, 63.6, and 53.3%, p = 0.015), respectively. Logistic regression analyses showed that educational attainment of primary or below showed significantly increased risks of DR (OR (95% CIs): 3.596 (1.453–8.899, p = 0.006)) and DKD (OR (95% CIs): 3.201 (1.244–8.242, p = 0.016)) as compared with that of college or above. There were significant trends of lower educational attainment with increased risks of DR and DKD (p values < 0.05).

Conclusion

PSG index were not significantly associated with DMC. But lower education was significantly associated with increased risks of DR and DKD, and strategies to prevent DMC for those with low education should be strengthened.

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Acknowledgements

We are grateful to all the patients for their participation.

Funding

C.L. was founded by Natural Science Foundation of China grant no: 81870611. Z.L. was founded by the National Key R&D Program of China grant no: 2017YFC0907100.ML was founded by Natural Science Foundation of Fujian Province grant no: 2017J01365.

Author contributions

The study concept and design were framed by C.D., Z.L., and C.L., C.D., C.H., S.Z., L.D., W.W., C.Z., and S.W. collected data. C.D., C.H., Z.L., and C.L. conducted the statistical data analysis and drafted the manuscript. M.L., X.J., and S.Y., contributed to discussion and revision. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. School of Medicine, **amen University, **amen, China

    Chunmin Du, Silan Zheng & Caiyu Zheng

  2. **amen Diabetes Institute, The First Affiliated Hospital, **amen University, **amen, China

    Chunmei He & Shuyu Yang

  3. The School of Clinical Medicine, Fujian Medical University, Fuzhou, China

    Lianqin Dong & Changqin Liu

  4. Department of Endocrinology and Diabetes, The First Affiliated Hospital, **amen University, **amen, China

    Wengui Wang, Shunhua Wang, MingZhu Lin, Xuejun Li & Changqin Liu

  5. Epidemiology Research Unit, The First Affiliated Hospital, **amen University, **amen, China

    Zhibin Li

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  1. Chunmin Du
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These authors contributed equally: Chunmin Du, Chunmei He

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Du, C., He, C., Dong, L. et al. Associations of apnea hypopnea index and educational attainments with microvascular complications in patients with T2DM. Endocrine 67, 363–373 (2020). https://doi.org/10.1007/s12020-020-02192-w

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