Sleep Apnea, Coronary Atherosclerosis and Heart Failure in Diabetes Patients With Nephropathy
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 74
- 试验地点
- 1
- 主要终点
- The association between sleep apnea and diastolic heart failure in patients with diabetic nephropathy.
研究概览
简要总结
Background:
Diabetes, and especially diabetic kidney disease is associated with the development of cardiovascular disease such as calcification in the coronary arteries and heart failure. Sleep apnea is frequent among patients with diabetes and diabetic kidney disease and sleep apnea itself is a solitary risk factor in the development of cardiovascular disease. Nonetheless, sleep apnea is underdiagnosed in diabetes patients because of a discrepancy between sleep apnea severity and actual oxygen deficiency symptoms which makes the diagnosis difficult. For that reason, many diabetics have undiagnosed sleep apnea together with cardiovascular disease. Early discovery of sleep apnea among high risk diabetic patients may therefore be considered crucial before cardiovascular complications develop. For this reason, sleep apnea screening of high-risk diabetics can possibly improve early diagnostics of cardiovascular disease.
Aim:
This study will seek to establish the association between obstructive sleep apnea (OSA) and coronary calcification and heart failure in patients with diabetic kidney disease. The basic hypothesis of the study is that patients with diabetic kidney disease and concurrent OSA have a higher prevalence and severity of coronary calcification and heart failure compared to patients without OSA.
Methods:
Diabetic adult patients with scheduled check-ups at Steno Diabetes Center Aarhus, or Department of Renal Medicine on Aarhus University Hospital will be included in the study.
Firstly, all included patients are screened for sleep apnea with the devices SomnoTouch® and ApneaLink®. Based on the sleep apnea determination; 40 patients with moderate-severe sleep apnea are compared with 40 patients without sleep apnea. In both groups, the patients are examined for calcification in the coronary vessels using a CT-scan while the function of the heart is examined by ultrasound (echocardiography). The stiffness of aorta is measured and performed using radial artery tonometry (SphygmoCor®).
Furthermore, range of blood- and urine samples will be performed
The perspectives are that patients with diabetes should be regularly evaluated for sleep apnea and that patients with moderate/severe sleep apnea should undergo further examination for cardiovascular disease even though the patients don't display any symptoms of either cardiovascular disease or sleep apnea.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Cross Sectional
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •≥ 18 years.
- •Diabetes Mellitus Type 2 with an eGFR between 10-60 ml/min/1,73 m^2 (Equalling CKD-group 3, 4 and 5 non-dialysis).
排除标准
- •Known sleep apnea in continuous positive airway pressure(CPAP) treatment.
- •Known mild sleep apnea (AHI 5-14) after the sleep apnea measurement.
- •Participants with central apnea (> 50 % of central apnea episodes in the AHI ≥ 15 group.) or Cheyne Stokes after the sleep apnea measurement.
- •< 4 hours of recording (ApneaLink)
- •Known coronary arterial disease with previous revascularization (PCI or CABG)
结局指标
主要结局
The association between sleep apnea and diastolic heart failure in patients with diabetic nephropathy.
时间窗: Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
All patients included in the study will undergo transthoracic echocardiography. Diastolic function is evaluated by E/e´. The echocardiographic-clinician is blinded to AHI-status.
The association between sleep apnea and coronary atherosclerosis (Agatston Score) measured with cardiac CT-scan in patients with diabetic nephropathy.
时间窗: Cardiac CT-scan will be performed no later than 1 month after inclusion. All Agatston scores will be estimated straight after the cardiac CT-scan.
The degree of atherosclerosis in the coronary artery walls is evaluated by cardiac CT-scan and subsequent quantified by Agatston score. Patients with an estimated glomerular filtration rate (eGFR) ≤ 25 ml/min/1,73 m2 is scanned without contrast whereas patients with an eGFR 26-60 ml/min/1,73 m2 are screened with contrast. All Agatston scoring will be performed by a cardiologist blinded to information on patient biochemical characteristics and AHI. The only biochemical parameter which the cardiologist is not blinded to is eGFR.
The association between sleep apnea and systolic function in patients with diabetic nephropathy.
时间窗: Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan
All patients included in the study will undergo transthoracic echocardiography. Systolic function is evaluated by Left Ventricular Global Longitudinal Strain (GLS). The echocardiographic-clinician is blinded to AHI-status.
次要结局
- Association between Fetuin-A(alfa-2-Heremans Schmid glycoprotein; AHSG) and coronary calcification in patients with sleep apnea and diabetic nephropathy.(Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021.)
- The association between sleep apnea and coronary plaque volume in patients with diabetic nephropathy.(Cardiac CT-scan will be performed no later than 1 month after inclusion.)
- Association between sRANKL (soluble receptor activator of nuclear factor kappa-B ligand) and coronary calcification in patients with sleep apnea and diabetic nephropathy.(Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021)
- Association between BsAP (bone-specific alkaline phosphatase) and coronary calcification in patients with sleep apnea and diabetic nephropathy.(Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021)
- Association between TRAP5B (tartrate-resistant acid phosphatase 5b) and coronary calcification in patients with sleep apnea and diabetic nephropathy.(Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021)
- Association between P1NP (procollagen type 1 N propeptide) and coronary calcification in patients with sleep apnea and diabetic nephropathy.(Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021)
- Association between IVSd (Interventricular Septal Thickness at Diastole) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.(Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan)
- Association between Aorta (Abdominalis) diameter as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.(Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan)
- Association between minimum Vena Cava Inferior diameter as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.(Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan)
- Association between E/A-ratio as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.(Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan)
- Association between Matrix Gla Protein (MGP) and coronary calcification in patients with sleep apnea and diabetic nephropathy.(Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021)
- Association between Aorta (Ascendens) diameter as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.(Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan)
- Association of sleep apnea and aortic stiffness (defined as Pulse Wave Velocity (PWV)) in patients with diabetic nephropathy.(PWV is performed the same day as the patient is included.)
- Association between PWTd (Posterior wall thickness at end-diastole) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.(Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan)
- Association between Aorta (sinus valsalva) diameter as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.(Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan)
- Association between Calcification propensity score (T50test) and coronary calcification in patients with sleep apnea and diabetic nephropathy.(Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021)
- Association between 25-OH-Vitamin D(D3+D2) and coronary calcification in patients with sleep apnea and diabetic nephropathy.(Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021)
- Association between Sclerostin and coronary calcification in patients with sleep apnea and diabetic nephropathy.(Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021)
- Association between IVSs (Interventricular Septal Thickness at Systole) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.(Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan)
- Association between Early mitral inflow velocity (E) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.(Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan)
- Association between osteoprotegerin and coronary calcification in patients with sleep apnea and diabetic nephropathy.(Analysis will be performed as batch-analysis at the end of inclusion of patients summer 2021)
- Association between LVEDd (Left ventricular end diastolic diameter) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.(Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan)
- Association between LVEDs (Left ventricular end systolic diameter) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.(Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan)
- Association between PWTs (Posterior wall thickness at end-systole) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.(Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan)
- Association between maximum Vena Cava Inferior diameter as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.(Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan)
- Association between Late mitral inflow velocity (A) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.(Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan)
- Association between Deceleration time of early diastolic transmittal flow (dtE) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.(Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan)
- Association between Right ventricular diameter (RVD) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.(Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan)
- Association between left atrial volume (LAV) as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.(Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan)
- Association between 2D atrial global strain as determined during echocardiography and sleep apnea in patients with diabetic nephropathy.(Transthoracic echocardiography will be performed no later than 1 month after inclusion and prior to cardiac CT-scan)