Risk Factors for Sleep Apnea Syndrome in Diabetic Patients with a Focus on Comorbidities
Authors: KAWASAKI SATSUKI , MISAWA HARUO , KANEDA RYO , KONDO TETSURI , KONDO YOSHINOBU , TERAUCHI YASUO 
Published: June 2018

Diabetic patients often have various diseases such as vascular diseases and other comorbidities. Sleep apnea syndrome (SAS) in such patients may lead to acute deterioration due to nocturnal hypoxia. Among the 1,367 ambulant patients with type 2 diabetes (T2DM) who were being treated at our institution, 483 (313 men and 170 women) who agreed to undergo a portable sleep polygraph test were evaluated to identify risk factors for SAS, with a focus on microangiopathy and stable comorbidities. The rates of intracranial lesions, respiratory diseases, cardiovascular diseases, cancer, thyroid diseases, and mental illness were 22%, 9.9%, 39.8%, 16.1%, 7.7%, and 5.8%, respectively. The rates of microangiopathy were as follows: retinopathy (30.6%) and nephropathy (48.5%). The patients had an apnea-hypopnea index (AHI) of 15.4±14.3 (mean±standard deviation) (16.8±14.5 in men and 12.9±13.8 in women). The prevalence of SAS (AHI≥15) was 40.6% (127/313) in men and 29.4% (50/170) in women. Intracranial lesions, cardiovascular diseases, and cancer were more common among patients with SAS than among those without SAS (AHI&lt;15) (p&lt;0.each), while no such association was found for microangiopathy. Multivariate analysis adjusting for known risk factors for SAS (BMI, male gender, and age) identified BMI (odds ratio, 1.25; 95% confidence interval, 1.18-1.33; p&lt;0.0001), male gender (2.11; 1.36-3.34; p&lt;0.001), and intracranial lesions (1.74; 1.07-2.83; p&lt;0.05) as independent risk factors for SAS. The intracranial lesions identified were stable and diverse, ranging from infarction and hemorrhage to benign brain tumor and encephalitis. The association of intracranial lesions with hypoxia may be related to the respiratory centers, although the underlying mechanism is unknown. Given the high prevalence of SAS, T2DM patients with obesity, male gender, and stable intracranial lesions should be carefully monitored for nocturnal hypoxia, particularly during emergency hospitalization.

Disclosure
S. Kawasaki: None. H. Misawa: None. R. Kaneda: None. T. Kondo: None. Y. Kondo: None. Y. Terauchi: Research Support; Self; MSD K.K.. Speaker's Bureau; Self; MSD K.K.. Advisory Panel; Self; MSD K.K.. Research Support; Self; Ono Pharmaceutical Co., Ltd.. Speaker's Bureau; Self; Ono Pharmaceutical Co., Ltd.. Research Support; Self; Novartis Pharma K.K., Boehringer Ingelheim GmbH. Speaker's Bureau; Self; Boehringer Ingelheim GmbH. Advisory Panel; Self; Boehringer Ingelheim GmbH. Research Support; Self; Mitsubishi Tanabe Pharma Corporation. Speaker's Bureau; Self; Mitsubishi Tanabe Pharma Corporation. Advisory Panel; Self; Mitsubishi Tanabe Pharma Corporation. Research Support; Self; Daiichi Sankyo Company, Limited. Speaker's Bureau; Self; Daiichi Sankyo Company, Limited. Advisory Panel; Self; Daiichi Sankyo Company, Limited. Research Support; Self; Sanwa Kagaku Kenkyusho Co., Ltd.. Speaker's Bureau; Self; Sanwa Kagaku Kenkyusho Co., Ltd.. Research Support; Self; Novo Nordisk Inc.. Speaker's Bureau; Self; Novo Nordisk Inc.. Advisory Panel; Self; Novo Nordisk Inc.. Research Support; Self; Eli Lilly and Company. Speaker's Bureau; Self; Eli Lilly and Company. Advisory Panel; Self; Eli Lilly and Company. Research Support; Self; Sanofi. Speaker's Bureau; Self; Sanofi. Advisory Panel; Self; Sanofi. Research Support; Self; Sumitomo Dainippon Pharma Co., Ltd.. Speaker's Bureau; Self; Sumitomo Dainippon Pharma Co., Ltd.. Research Support; Self; Shionogi & Co., Ltd.. Speaker's Bureau; Self; Shionogi & Co., Ltd., Bayer Yakuhin, Ltd., Astellas Pharma US, Inc., AstraZeneca. Advisory Panel; Self; AstraZeneca, Teijin Pharma Limited.