BMI与腰围对阻塞性睡眠呼吸暂停与2型糖尿病的中介效应

陈淑婷; 王佳乐; 王菊平; 高倩; 梁洁; 王彤

doi:10.16462/j.cnki.zhjbkz.2022.05.006

BMI与腰围对阻塞性睡眠呼吸暂停与2型糖尿病的中介效应

doi: 10.16462/j.cnki.zhjbkz.2022.05.006

030001 太原，山西医科大学公共卫生学院卫生统计学教研室

基金项目:

国家自然科学基金 82073674

国家自然科学基金 81872715

山西省科技重大专项项目 202102130501003

山西省科技重大专项项目 202005D121008

详细信息

通讯作者:
王彤，E-mail: tongwang@sxmu.edu.cn

中图分类号: R181.3+8
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出版历程
- 收稿日期: 2021-11-08
- 修回日期: 2022-02-22
- 网络出版日期: 2022-05-11
- 刊出日期: 2022-05-10

Mediating effect of body mass index and waist circumference on the relationship between obstructive sleep apnea and type 2 diabetes

Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan 030001, China

Funds:

National Natural Science Foundation of China 82073674

National Natural Science Foundation of China 81872715

The Grant of the Major Science and Technology Project of Shanxi Province 202102130501003

The Grant of the Major Science and Technology Project of Shanxi Province 202005D121008

More Information

Corresponding author: WANG Tong, E-mail: tongwang@sxmu.edu.cn

摘要

摘要: 目的探究BMI和腰围(waist circumference, WC)对阻塞性睡眠呼吸暂停(obstructive sleep apnea, OSA)与2型糖尿病、糖代谢连续测量指标之间的中介效应。方法纳入分析的1 615名研究对象来自动脉粥样硬化多民族研究(Multi-Ethnic Study of Atherosclerosis, MESA)。OSA评价指标为呼吸暂停低通气指数(apnea-hypopnea index，AHI)，由多导睡眠图测定。糖代谢连续测量指标包括FPG和糖化血红蛋白(glycated hemoglobin，HbA1c)。肥胖指标包括全身肥胖指标BMI和腹型肥胖指标WC。结果 OSA与2型糖尿病显著相关，后者的患病风险随OSA严重程度增加而升高(P < 0.001)。BMI和WC均介导重度OSA与2型糖尿病之间的关联，其中腹型肥胖指标WC的中介效应为1.296(95% CI: 1.182~1.466)，中介效应比例为56.397%；BMI的中介效应为1.291(95% CI: 1.173~1.479)，中介效应比例为55.400%。BMI和WC同样介导重度OSA与FPG、HbA1c之间的关联。结论 OSA与2型糖尿病、FPG和HbA1c的关系，与肥胖程度增加有关。提示OSA患者通过早期的体重干预，特别是控制腹型肥胖对降低糖尿病和心血管并发症的患病率具有重要意义。
- 阻塞性睡眠呼吸暂停综合征 /
- 2型糖尿病 /
- 中介效应 /
- 肥胖
Abstract: Objective To evaluate the mediating effect of BMI and waist circumference (WC)on the relationships between obstructive sleep apnea (OSA) and type 2 diabetes and continuous measures of glucose metabolism. Methods A total of 1 615 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) were included in this cross-sectional study. OSA severity was assessed by apnea-hypopnea index (AHI), which was measured by polysomnography. Continuous measures of glucose metabolism were FPG and glycated hemoglobin (HbA1c). And obesity indexes used in this study included general obesity (BMI) and abdominal obesity (WC). Results OSA was significantly associated with type 2 diabetes. With increasing the severity of OSA, there was a significant increase in the risk of type 2 diabetes (P < 0.001). Mediation analysis showed that BMI and WC mediated the association between severe OSA and type 2 diabetes, respectively. The indirect effect mediated by WC and BMI were 1.296 (95% CI: 1.182-1.466) and 1.291 (95% CI: 1.173-1.479), and the proportion of mediation were 56.397% and 55.400%, respectively. Similarly, BMI and WC mediated the associations between OSA and FPG and HbA1c. Conclusions These findings show that the associations between OSA and type 2 diabetes, FPG and HbA1c are mediated by obesity indexes to a large proportion. It is suggested that weight control, especially reducing abdominal obesity, may have an important role for OSA patients in decreasing the risk of type 2 diabetes and related cardiovascular complications.
- Obstructive sleep apnea syndrome /
- Type 2 diabetes /
- Mediation analysis /
- Obesity

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图 1 中介效应分析图

Figure 1. Mediation analysis

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表 1 研究对象的一般特征

Table 1. General characteristics of participants

变量	全部样本 (N=1 615)	2型糖尿病		χ²/Z ^b	P值^a
变量	全部样本 (N=1 615)	否(n=1 301)	是(n=314)	χ²/Z ^b	P值^a
年龄[M(P₂₅, P₇₅), 岁]	67(61, 75)	67(60, 75)	68(62, 76)	1.763	0.078
性别[n(%)]				1.399	0.237
男	790(48.92)	627(48.19)	163(51.91)
女	825(51.08)	674(51.81)	151(48.09)
种族/民族[n(%)]				48.586	< 0.001
白人	591(36.59)	523(40.20)	68(21.66)
美国华裔	203(12.57)	171(13.14)	32(10.19)
黑人或美国非裔	447(27.68)	329(25.29)	118(37.58)
西班牙人	374(41.56)	278(21.37)	96(30.57)
饮酒[n(%)]	725(44.89)	615(47.27)	110(35.03)	15.317	< 0.001
吸烟情况[n(%)]				6.967	0.031
从未吸烟	750(46.44)	610(46.89)	140(44.59)
曾经吸烟	759(47.00)	616(47.35)	143(45.54)
现在吸烟	106(6.56)	75(5.76)	31(9.87)
身体活动水平 [M(P₂₅, P₇₅), MET-min/周]	3 660(1 740, 7 200)	3 780(1 830, 7 360)	3 105(1 350, 6 570)	-2.814	0.005
eGFR [M(P₂₅, P₇₅), ml·min^-1·1.73m^-2]	82.93(69.16, 93.40)	82.93(70.27, 93.08)	82.95(63.77, 94.51)	-0.648	0.517
TG[M(P₂₅, P₇₅), mg/dl]	95(70, 129)	93(68, 124)	105(78, 143)	4.383	< 0.001
TC[M(P₂₅, P₇₅), mg/dl]	182(157, 206)	186(163, 208)	158(135, 188)	-10.733	< 0.001
HDL-C[M(P₂₅, P₇₅), mg/dl]	53(44, 64)	54(45, 66)	49(41, 57)	-6.572	< 0.001
LDL-C[M(P₂₅, P₇₅), mg/dl]	103(82, 127)	108(88, 129)	83(66, 111)	-10.322	< 0.001
高血压[n(%)]	908(56.22)	668(51.35)	240(76.43)	64.685	< 0.001
充血性心力衰竭[n(%)]	44(2.72)	24(1.84)	20(6.37)	19.540	< 0.001
心肌梗死[n(%)]	54(3.34)	38(2.92)	16(5.10)	3.702	0.054
中风[n(%)]	42(2.60)	31(2.38)	11(3.50)	1.254	0.263
注：连续变量表示为中位数和四分位间距，分类变量为频数和构成比；^a表示是否患2型糖尿病两组比较的P值。^b Z值为连续变量组间比较采用Wilcoxon秩和检验的统计量，χ²为分类变量组间比较采用Pearson χ²检验的统计量。

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表 2 研究对象的OSA、肥胖指标和糖代谢测量指标差异

Table 2. Characteristics of participants with OSA, obesity indexes and measures of glucose metabolism

变量	全部样本 (N=1 615)	2型糖尿病		χ²/Z ^b值	P值^a
变量	全部样本 (N=1 615)	否(n=1 301)	是(n=314)	χ²/Z ^b值	P值^a
OSA[n(%)]	1 135(70.28)	887(68.18)	248(78.98)	14.132	< 0.001
AHI < 5	480(29.72)	414(31.82)	66(21.02)	28.854	< 0.001
5≤AHI < 15	542(33.56)	448(34.44)	94(29.94)
15≤AHI < 30	325(20.12)	246(18.91)	79(25.16)
AHI≥30	268(16.59)	193(14.83)	75(23.89)
肥胖指标[M(P₂₅, P₇₅)]
BMI(kg/m²)	27.83(24.73, 31.61)	27.41(24.38, 30.82)	30.50(26.91, 34.45)	8.562	< 0.001
WC(cm)	98.00(89.50, 107.20)	96.80(88.50, 105.10)	104.15(96.00, 114.50)	8.970	< 0.001
糖代谢测量指标[M(P₂₅, P₇₅)]
FPG(mg/dl)	95.00(88.00, 105.00)	93.00(87.00, 100.00)	122.00(103.00, 143.00)	19.329	< 0.001
HbA1c ^c(%)	5.80(5.50, 6.20)	5.70(5.40, 5.90)	6.70(6.20, 7.50)	22.497	< 0.001
注：^aP值表示是否患2型糖尿病两组间比较的结果；^bZ值为连续变量组间比较采用Wilcoxon秩和检验的统计量，χ²为分类变量组间比较采用Pearson χ²检验的统计量；^cHbA1c：全部样本(N=1 611)，非2型糖尿病(n=1 299)，2型糖尿病(n=312)。

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表 3 不同AHI水平与2型糖尿病的关系

Table 3. Association between different levels of AHI and type 2 diabetes

2型糖尿病	AHI[OR (95% CI)值]				P_趋势值
2型糖尿病	AHI < 5	5≤AHI < 15	15≤AHI < 30	AHI≥30	P_趋势值
模型1	1.000	1.316(0.935~1.853)	2.014(1.401~2.896)	2.438(1.680~3.537)	< 0.001
模型2	1.000	1.263(0.891~1.791)	1.872(1.289~2.719)	2.226(1.511~3.280)	< 0.001
模型3	1.000	1.281(0.886~1.851)	1.851(1.245~2.753)	2.188(1.446~3.312)	< 0.001
注：模型1单变量模型；模型2校正年龄，性别和种族/民族；模型3在模型2的基础上校正饮酒、吸烟、身体活动水平、eGFR、TC、LDL-C、高血压、充血性心力衰竭、心肌梗死和中风。

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表 4 重度OSA(AHI≥30)与2型糖尿病、糖代谢测量指标之间的关系

Table 4. Association between severe OSA (AHI≥30) and type 2 diabetes and measures of glucose metabolism

AHI≥30	2型糖尿病		FPG		HbA1c
AHI≥30	OR(95% CI)值	P值	β(95% CI)值	P值	β(95% CI)值	P值
模型1	1.802(1.328~2.427)	< 0.001	0.072(0.045~0.098)	< 0.001	0.041(0.025~0.058)	< 0.001
模型2	1.676(1.223~2.281)	0.001	0.061(0.035~0.087)	< 0.001	0.040(0.024~0.056)	< 0.001
模型3	1.645(1.173~2.296)	0.004	0.053(0.027~0.079)	0.001	0.037(0.021~0.053)	< 0.001
注：模型1单变量模型；模型2校正年龄，性别和种族/民族；模型3在模型2的基础上校正饮酒、吸烟、身体活动水平、eGFR、TC、LDL-C、高血压、充血性心力衰竭、心肌梗死和中风。

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表 5 重度OSA(AHI≥30)与肥胖指标的关系

Table 5. Association between severe OSA (AHI≥30) and obesity indexes

AHI≥30 ^a	β(95% CI)值	P值
BMI(kg/m²)	0.114(0.093~0.136)	< 0.001
WC(cm)	0.073(0.055~0.090)	< 0.001
注：^a模型中校正年龄、性别、种族/民族、饮酒、吸烟、身体活动水平、eGFR、TC、LDL-C、高血压、充血性心力衰竭、心肌梗死和中风。

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表 6 肥胖对重度OSA(AHI≥30)与2型糖尿病和糖代谢测量指标之间的中介效应

Table 6. The mediating effect of obesity indexes on the relationship between severe obstructive sleep apnea (AHI≥30) with type 2 diabetes and measures of glucose metabolism

肥胖与糖尿病	直接效应 OR(95% CI)值/ β(95% CI)值	间接效应 OR(95% CI)值/ β(95% CI)值	中介效应比例(%)
BMI(kg/m²)
2型糖尿病	1.306(0.919~1.844)	1.291(1.173~1.479) ^a	55.400
FPG	0.037(0.009~0.070) ^a	0.016(0.008~0.020) ^a	29.614
HbA1c	0.028(0.011~0.046) ^a	0.009(0.005~0.013) ^a	23.539
WC(cm)
2型糖尿病	1.297(0.897~1.801)	1.296(1.182~1.466) ^a	56.397
FPG	0.035(0.008~0.066) ^a	0.018(0.011~0.027) ^a	33.843
HbA1c	0.027(0.011~0.045) ^a	0.010(0.006~0.014) ^a	26.455
注：2型糖尿病的直接效应和间接效应结果表示为OR (95% CI)值；FPG和HbA1c的直接效应和间接效应结果表示为β (95% CI)值；^a OR (95% CI)值不包括1或者β (95% CI)值不包括0，表示P < 0.05。

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