Case Control Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2022; 28(21): 2320-2333
Published online Jun 7, 2022. doi: 10.3748/wjg.v28.i21.2320
Intermittent hypoxia is involved in gut microbial dysbiosis in type 2 diabetes mellitus and obstructive sleep apnea-hypopnea syndrome
Sha-Sha Tang, Cheng-Hong Liang, Ya-Lei Liu, Wei Wei, Xin-Ru Deng, Xiao-Yang Shi, Li-Min Wang, Li-Jun Zhang, Hui-Juan Yuan
Sha-Sha Tang, Cheng-Hong Liang, Ya-Lei Liu, Wei Wei, Xin-Ru Deng, Xiao-Yang Shi, Li-Min Wang, Li-Jun Zhang, Hui-Juan Yuan, Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou 450003, Henan Province, China
Author contributions: Tang SS designed the research and conducted microbiome analysis; Liu YL conducted the research except the microbiome analysis; Tang SS and Liang CH analyzed the microbiome data and wrote the paper; all other data were analyzed by Shi XY and Deng XR with oversight by Wei W; Zhang LJ and Wang LM were responsible for the data acquisition and input and proofreading of the manuscript; Tang SS and Yuan HJ had primary responsibility for the final content; all authors have read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81970705; and Central Plains Thousand Talents Plan, No. 204200510026.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Henan Provincial People’s Hospital (IRB No. 2019-62).
Informed consent statement: All study participants provided informed written consent before the study enrollment.
Conflict-of-interest statement: All authors declare no conflicts of interest.
Data sharing statement: Raw sequencing data and associated metadata were deposited in the NCBI short-read archive with BioProject accession number PRJNA788301.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hui-Juan Yuan, PhD, Chief Doctor, Department of Endocrinology, Henan Provincial Key Medicine Laboratory of Intestinal Microecology and Diabetes, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, No. 7 Weiwu Road, Zhengzhou 450003, Henan Province, China. hjyuan@zzu.edu.cn
Received: January 8, 2022
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
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.