Association between obstructive sleep apnea severity and endothelial dysfunction in patients with type 2 diabetes.
Obstructive sleep apnea (OSA) and type 2 diabetes (T2D) are associated with endothelial dysfunction a main predictor of late cardiovascular (CV) events. Despite the high prevalence of OSA in patients with T2D, the impact of OSA severity on endothelial function has not been clearly elucidated. The aim of this cross-sectional study was to determine whether increasing OSA severity is associated with poorer endothelial function in patients with T2D.



140 patients with T2D and no overt CV disease underwent polysomnography, peripheral arterial tonometry, clinic blood pressure (BP) measurement, biological assessment for CV risk factors, daytime sleepiness and health related quality of life (HRQL) questionnaires. The following commonly used cut-offs for apnea-hypopnea index (AHI) were used to define 3 categories of disease severity: AHI < 15 (no OSA or mild OSA), 15 ≤ AHI < 30 (moderate OSA), and AHI ≥ 30 (severe OSA). The primary outcome was the reactive hyperemia index (RHI), a validated assessment of endothelial function.



21.4% of patients had moderate OSA and 47.6% had severe OSA. Increasing OSA severity and nocturnal hypoxemia were not associated with a significant decrease in RHI. Endothelial dysfunction (RHI < 1.67) was found in 47.1, 44.4 and 39.2% of patients with no OSA or mild OSA, moderate OSA and severe OSA, respectively (p = 0.76). After adjustment for confounders including body mass index, increasing OSA severity was associated with higher systolic BP (p = 0.03), lower circulating levels of adiponectin (p = 0.0009), higher levels of sP-selectin (p = 0.03), lower scores in 3 domains of HRQL including energy/vitality (p = 0.02), role functioning (p = 0.01), and social functioning (p = 0.04).



Moderate to severe OSA is very common but has no impact on digital micro-vascular endothelial function in patients with T2D.
Université Bretagne Loire, INSERM UMR 1063, Angers, France.
Vanessa
V
Bironneau
Service de Pneumologie, Centre Hospitalier, Le Mans, France.
François
F
Goupil
Unité d'Endocrinologie-Diabétologie-Nutrition, Pole de Médecine, CHRU de Tours, Tours, France.
Pierre Henri
PH
Ducluzeau
Centre de Recherche Médecine, Sciences, Santé, Santé mentale, Société, CNRS UMR 8211, INSERM UMR U988-EHESS, Villejuif, France.
Marc
M
Le Vaillant
Département de Médecine du Sport et Explorations Fonctionnelles Vasculaires, Université Bretagne Loire, CHU d'Angers, Angers, France.
Pierre
P
Abraham
Département de Médecine du Sport et Explorations Fonctionnelles Vasculaires, Université Bretagne Loire, CHU d'Angers, Angers, France.
Samir
S
Henni
Département d'Endocrinologie, Diabétologie, Nutrition, Université Bretagne Loire, CHU d'Angers, Angers, France.
Séverine
S
Dubois
Service de Pneumologie, Centre Hospitalier, Le Mans, France.
Audrey
A
Paris
Université Bretagne Loire, INSERM UMR 1063, Angers, France.|Département de Pneumologie, Université Bretagne Loire, CHU d'Angers, 4 Rue Larrey, 49100, Angers, France.
Pascaline
P
Priou
Université Bretagne Loire, INSERM UMR 1063, Angers, France.|Département de Pneumologie, Université Bretagne Loire, CHU d'Angers, 4 Rue Larrey, 49100, Angers, France.
Nicole
N
Meslier
Service d'Endocrinologie, Diabétologie, Centre Hospitalier, Le Mans, France.
Claire
C
Sanguin
Université Bretagne Loire, INSERM UMR 1063, Angers, France.|Département de Pneumologie, Université Bretagne Loire, CHU d'Angers, 4 Rue Larrey, 49100, Angers, France.
Wojciech
W
Trzépizur
Université Bretagne Loire, INSERM UMR 1063, Angers, France.
Ramaroson
R
Andriantsitohaina
Université Bretagne Loire, INSERM UMR 1063, Angers, France.
Maria Carmen
MC
Martinez
Université Bretagne Loire, INSERM UMR 1063, Angers, France. frgagnadoux@chu-angers.fr.|Département de Pneumologie, Université Bretagne Loire, CHU d'Angers, 4 Rue Larrey, 49100, Angers, France. frgagnadoux@chu-angers.fr.
Frédéric
F
Gagnadoux
D000368:Aged; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*
Endothelial function; Obstructive sleep apnea; Peripheral arterial tonometry; Reactive hyperemia index; Type 2 diabetes