Published online Jun 7, 2022. doi: 10.3748/wjg.v28.i21.2320
Peer-review started: January 8, 2022
First decision: March 9, 2022
Revised: March 19, 2022
Accepted: April 22, 2022
Article in press: April 22, 2022
Published online: June 7, 2022
Processing time: 145 Days and 8.7 Hours
Obstructive sleep apnea (OSA)-hypopnea syndrome (OSAHS), as a chronic and treatable sleep disorder, has a high prevalence in type 2 diabetes mellitus (T2DM) patients. As a landmark feature of OSAHS, intermittent hypoxia (IH) plays an important role in the occurrence and development of related complications in T2DM patients. However, the pathological mechanisms are varied and unknown. Therefore, it is important to study the role of gut microbiota, a meaningful new target, in T2DM patients with OSAHS.
In recent years, it has been found that gut microbiota imbalance is related to metabolic diseases. However, most studies have not discussed the relationship between gut microbiota changes and T2DM patients with OSAHS.
In this study we focused on IH that might be involved in altering the gut dysbiosis in T2DM patients with OSAHS. Meanwhile, we further assessed the changes of clinical indicators and inflammatory factors related to dysbiosis, aiming to provide new targets and perspectives for the pathogenesis and prevention strategies of T2DM patients complicated with OSAHS.
A case-control study was conducted to select subjects who were divided into T2DM + OSA group, T2DM group, and healthy control group. They were examined with a type IV portable monitor overnight. The clinical indexes, respiratory parameters, inflammatory indexes, and gut microbial community of the three groups were measured.
Among the three groups, T2DM + OSA group showed the most severe changes in sleep apnea parameters and increased systemic inflammatory factors. We found the decreased levels of short-chain fatty acid-related Faecalibacterium, Eubacterium, and Lachnospiraceae and the increased levels of Actinomyces at the amplicon sequence variant level. The changes in these gut microbiotas were closely related to clinical indicators as well.
IH may be involved in the selective changes of intestinal microbiota, which may be related to the increased intestinal permeability and systemic inflammation response in T2DM patients with OSAHS.
This study shows that IH may change the state of gut microbiota and systemic inflammation, which participate in the occurrence and development of T2MD complicated with OSAHS. In the future, large-scale clinical randomized controlled prospective trials and animal trials may be needed to further explore the corresponding causality.