OBJECTIVE: Growing evidence indicates that both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) may be related to increased risk of developing metabolic disorder and cardiovascular diseases. However, the association of sleep overlap syndrome (combination of COPD and OSA) with type 2 diabetes is unclear. The aim of this study was to investigate the association between overlap syndrome and prevalence of type 2 diabetes. METHODS: In this study, 1 939 patients who completed home sleep test from January 2011 to December 2014 in sleep center of Beijing Anzhen Hospital were retrospectively studied. Sleep events were scored by experienced sleep technicians. COPD were diagnosed according to clinical manifestation and spirometry, while OSA was defined by apnea-hypopnea index ≥15 event/h. All subjects were divided retrospectively into overlap syndrome group (n=1 093), isolated COPD group (n=62), isolated OSA group (n=735), and control group (n=49). The independent association of overlap syndrome with type 2 diabetes prevalence was estimated by using Logistic regression models. RESULTS: Compared with control group and the patients with isolated OSA, the patients with overlap syndrome had significantly higher odds of type 2 diabetes (OR=5.82, 95%CI: 3.23-10.48, P<0.001 and OR=4.35, 95%CI: 2.41-7.88, P<0.001), with significance persisting after adjusting for age, sex, and body mass index as confounding factors (OR=2.69, 95%CI: 1.13-6.52, P=0.026 and OR=3.64, 95%CI: 1.53-8.83, P=0.004). Among those younger than 58 years or female subjects, overlap syndrome had independent association with type 2 diabetes (OR=8.45, 95%CI: 1.46-65.90, P=0.018 and OR=4.39, 95%CI: 1.04-22.50, P=0.044). No significant association was found in the patients ≥58 and male subjects. CONCLUSION Sleep overlap syndrome is associated with high prevalence of type 2 diabetes. Further study is needed to verify whether treatment toward overlap syndrome may reduce risk of metabolic disorder, and even decrease long-term risk of complications of diabetes.
Cross-Sectional Studies ; Diabetes Mellitus, Type 2 ; Female ; Humans ; Male ; Retrospective Studies ; Risk Factors ; Sleep Apnea, Obstructive ; Undifferentiated Connective Tissue Diseases

OBJECTIVE: To investigate the fetal and maternal outcomes, risk factors of disease progression and adverse pregnancy outcomes (APOs) in patients with undifferentiated connective tissue disease (UCTD). METHODS: This retrospective study described the outcomes of 106 pregnancies in patients with UCTD. The patients were divided into APOs group (n=53) and non-APOs group (n=53). The APOs were defined as miscarriage, premature birth, pre-eclampsia, premature rupture of membranes (PROM), intrauterine growth restriction (IUGR), postpartum hemorrhage (PPH), and stillbirth, small for gestational age infant (SGA), low birth weight infant (LBW) and birth defects. The differences in clinical manifestations, laboratory data and pregnancy outcomes between the two groups were compared. Logistic regression analysis was performed to analyze the risk factors for APOs and the progression of UCTD to definitive CTD. RESULTS: There were 99 (93.39%) live births, 4 (3.77%) stillbirths and 3 (2.83%) miscarriage, 20 (18.86%) preterm delivery, 6 (5.66%) SGA, 17 (16.03%) LBW, 11 (10.37%) pre-eclampsia, 7 (6.60%) cases IUGR, 19 (17.92%) cases PROM, 10 (9.43%) cases PPH. Compared with the patients without APOs, the patients with APOs had a higher positive rate of anti-SSA antibodies (73.58% vs. 54.71%, P=0.036), higher rate of leukopenia (15.09% vs. 3.77%, P=0.046), lower haemoglobin level [109.00 (99.50, 118.00) g/L vs. 124.00 (111.50, 132.00) g/L, P < 0.001].Multivariate Logistic regression analysis showed that leucopenia (OR=0.82, 95%CI: 0.688-0.994) was an independent risk factors for APOs in UCTD (P=0.042). Within a mean follow-up time of 5.00 (3.00, 7.00) years, the rate of disease progression to a definite CTD was 14.15%, including 8 (7.54%) Sjögren's syndrome, 4 (3.77%) systemic lupus erythematosus (SLE), 4 (3.77%) rheumatoid arthritis and 1 (0.94%) mixed connective tissue disease. Multivariate Cox proportional risk regression analysis showed that Raynaud phenomenon (HR=40.157, 95%CI: 3.172-508.326) was an independent risk factor for progression to SLE. CONCLUSION Leukopenia is an independent risk factor for the development of APOs in patients with UCTD. Raynaud's phenmon is a risk factor for the progression of SLE. Tight disease monitoring and regular follow-up are the key measures to prevent adverse pregnancy outcomes and predict disease progression in UCTD patients with pregnancy.
Pregnancy ; Infant, Newborn ; Female ; Humans ; Pregnancy Outcome ; Retrospective Studies ; Abortion, Spontaneous/etiology* ; Undifferentiated Connective Tissue Diseases ; Pre-Eclampsia/epidemiology* ; Lupus Erythematosus, Systemic ; Risk Factors ; Leukopenia ; Pregnancy Complications/epidemiology* ; Disease Progression ; Connective Tissue Diseases/epidemiology*