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

  • Chunmin Du
  • Chunmei He
  • Lianqin Dong
  • Silan Zheng
  • Wengui Wang
  • Caiyu Zheng
  • Shunhua Wang
  • MingZhu Lin
  • Shuyu Yang
  • Xuejun Li
  • Zhibin LiEmail author
  • Changqin LiuEmail author
Original Article



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.


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.


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).


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.


Obstructive sleep apnea Education Diabetic microvascular complications Diabetic retinopathy Diabetic kidney disease Diabetic peripheral neuropathy 



We are grateful to all the patients for their participation.


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.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Authors and Affiliations

  1. 1.School of MedicineXiamen UniversityXiamenChina
  2. 2.Xiamen Diabetes Institute, The First Affiliated HospitalXiamen UniversityXiamenChina
  3. 3.The School of Clinical MedicineFujian Medical UniversityFuzhouChina
  4. 4.Department of Endocrinology and Diabetes, The First Affiliated HospitalXiamen UniversityXiamenChina
  5. 5.Epidemiology Research Unit, The First Affiliated HospitalXiamen UniversityXiamenChina

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