睡眠时间与糖尿病性视网膜病变风险关系的meta分析

doi:10.3969/j.issn.1674-8115.2021.11.015

摘要/Abstract

摘要：

目的·采用meta分析探讨睡眠时间与糖尿病性视网膜病变（diabetic retinopathy，DR）风险的关系。方法·计算机检索Cochrane Library、PubMed、Embase、Web of Science、中国生物医学文摘数据库、中国知网、维普数据库和万方数据知识服务平台等数据库，检索时间从建库至2021年4月。英文检索词包括“sleep”“sleep duration”“sleep time”“sleeping habit”“quantity of sleep”“diabetic retinopathy”和“retinal diseases”，中文检索词为“睡眠”“睡眠时间”“糖尿病性视网膜病变”。收集各数据库中发表的有关睡眠时间与发生DR风险关系的文献，文献类型为观察性研究，包括横断面研究、病例对照研究和队列研究。由2名研究人员独立筛选文献、提取数据和评价纳入文献的质量。提取的数据包括第一作者、研究地区、发表时间、研究类型、样本量、年龄、睡眠时间评估方法、睡眠时间分组、结局指标、校正混杂因素。采用纽卡斯尔-渥太华量表评价纳入文献的质量。使用R 4.0.4软件进行meta分析。结果·共纳入5篇文献，包含研究对象5 627例。Meta分析结果表明：长睡眠时间与DR发生的风险呈正相关［固定效应模型和随机效应模型合并效应量比值比（odds ratio，OR）均为2.05，95%置信区间（confidence interval，CI）1.37~3.05］，短睡眠时间与DR的发生风险无关（固定效应模型OR=0.89，95%CI 0.72~1.10；随机效应模型OR=0.98，95%CI 0.71~1.37），但与中度DR的发生相关（固定效应模型OR=2.07，95%CI 1.29~3.33；随机效应模型OR=2.06，95%CI 1.18~3.58）；短睡眠时间与威胁视力的糖尿病视网膜病变风险无关（固定效应模型和随机效应模型OR均为0.92，95%CI 0.58~1.47）。结论·睡眠时间与DR患病风险存在显著关联。其中，过长的睡眠时间是DR的危险因素，而短睡眠时间则待研究进一步确定。作为个人层面的可改变因素，睡眠干预对于DR管理的作用应当得到进一步重视。

关键词: 睡眠时间, 糖尿病性视网膜病变, meta分析

Abstract:

Objective·To explore the relationship between sleep duration and the risk of diabetic retinopathy (DR) by performing a meta-analysis.

Methods·The databases of Cochrane Library, PubMed, Embase, Web of Science, SinoMed, CNKI, VIP, and WanFang were searched for eligible studies regarding the relationship between sleep duration and the risk of DR up to April 2021. English search terms included "sleep" "sleep duration" "sleep time" "sleeping habit" "quantity of sleep diabetic retinopathy" and "retinal diseases". Chinese search terms included "睡眠" "睡眠时间" and "糖尿病性视网膜病变". The type of literature was observational studies, including cross-sectional studies, case-control studies, and cohort studies. Two researchers independently screened the literature and extracted data. The extracted data included the first author, country, publication time, study type, sample size, mean age, exposure assessment, sleep duration, outcome assessment, adjusted variables. The Newcastle-Qttawa Scale (NOS) was used to evaluate the quality of the included studies and a meta-analysis was performed by using R 4.0.4 software.

Results·A total of 1 146 documents were retrieved, and 5 met the inclusion criteria, including 5 627 study subjects. Results showed that long sleep duration was positively correlated with the risk of any DR [the combined odds ratio(OR) in the fixed-effect model and random-effect model both were 2.05, 95% confidence interval (CI) 1.37?3.05) ], while short sleep duration was not associated with the risk of any DR (OR in the fixed-effect model and random-effect model were 0.89, 95%CI 0.72?1.10 and 0.98, 95%CI 0.71?1.37, respectively], but it was related to the risk of moderate DR (OR in the fixed-effect model and random-effect model were2.07, 95%CI 1.29?3.33 and 2.06, 95% CI 1.18?3.58, respectively). Short sleep duration was not associated with the risk of vision-threatening diabetic retinopathy (OR in the fixed-effect model and random-effect model both were 0.92, 95%CI 0.58?1.47).

Conclusion·Sleep duration is significantly associated with the risk of DR, in which too much sleep is a risk factor, while short sleep is to be further determined by research. As a modifiable factor at the individual level, the role of sleep intervention in the management of DR should be further emphasized.

Key words: sleep duration, diabetic retinopathy, meta-analysis

中图分类号:

R587.2

刘洁, 谢新民, 支雪梅, 陆静毅. 睡眠时间与糖尿病性视网膜病变风险关系的meta分析[J]. 上海交通大学学报(医学版), 2021, 41(11): 1502-1508.

Jie LIU, Xin-min XIE, Xue-mei ZHI, Jing-yi LU. Meta-analysis of the relationship between sleep duration and the risk of diabetic retinopathy[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(11): 1502-1508.

图/表 6

参考文献 34

1	Arden GB, Sivaprasad S. The pathogenesis of early retinal changes of diabetic retinopathy[J]. Doc Ophthalmol, 2012, 124(1): 15-26.
2	Li YZ, Teng D, Shi XG, et al. Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study[J]. BMJ, 2020, 369: m997.
3	钟学礼(执笔. 全国14省市30万人口中糖尿病调查报告[J]. 中华内科杂志, 1981, 20(11): 678-683.
4	Liew G, Michaelides M, Bunce C. A comparison of the causes of blindness certifications in England and Wales in working age adults (16–64 years), 1999–2000 with 2009–2010[J]. BMJ Open, 2014, 4(2): e004015.
5	Xu TL, Wang BS, Liu H, et al. Prevalence and causes of vision loss in China from 1990 to 2019: findings from the Global Burden of Disease Study 2019[J]. Lancet Public Heal, 2020, 5(12): e682-e691.
6	Jampol LM, Glassman AR, Sun J. Evaluation and care of patients with diabetic retinopathy[J]. N Engl J Med, 2020, 382(17): 1629-1637.
7	Association AD. 11. microvascular complications and foot care: standards of medical care in diabetes—2021[J]. Dia Care, 2021, 44(): S151-S167.
8	Shan ZL, Ma HF, Xie ML, et al. Sleep duration and risk of type 2 diabetes: a meta-analysis of prospective studies[J]. Dia Care, 2015, 38(3): 529-537.
9	Meng LL, Liu Y, Geng RN, et al. Association of diabetic vascular complications with poor sleep complaints[J]. Diabetol Metab Syndr, 2016, 8: 80.
10	Jee D, Keum N, Kang S, et al. Sleep and diabetic retinopathy[J]. Acta Ophthalmol, 2017, 95(1): 41-47.
11	Chew M, Tan NYQ, Lamoureux E, et al. The associations of objectively measured sleep duration and sleep disturbances with diabetic retinopathy[J]. Diabetes Res Clin Pract, 2020, 159: 107967.
12	Raman R, Gupta A, Venkatesh K, et al. Abnormal sleep patterns in subjects with type Ⅱ diabetes mellitus and its effect on diabetic microangiopathies: Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN-DREAMS, report 20)[J]. Acta Diabetol, 2012, 49(4): 255-261.
13	Tan NYQ, Chew M, Tham YC, et al. Associations between sleep duration, sleep quality and diabetic retinopathy[J]. PLoS One, 2018, 13(5): e0196399.
14	Wang X, Bi Y, Zhang Q, et al. Obstructive sleep apnoea and the risk of type 2 diabetes: a meta-analysis of prospective cohort studies[J]. Respirology, 2013, 18(1): 140-146.
15	Williams CJ, Hu FB, Patel SR, et al. Sleep duration and snoring in relation to biomarkers of cardiovascular disease risk among women with type 2 diabetes[J]. Diabetes Care, 2007, 30(5): 1233-1240.
16	Zizi F, Jean-Louis G, Brown CD, et al. Sleep duration and the risk of diabetes mellitus: epidemiologic evidence and pathophysiologic insights[J]. Curr Diab Rep, 2010, 10(1): 43-47.
17	Linsenmeier RA. Effects of light and darkness on oxygen distribution and consumption in the cat retina[J]. J Gen Physiol, 1986, 88(4): 521-542.
18	Ramsey DJ, Arden GB. Hypoxia and dark adaptation in diabetic retinopathy: interactions, consequences, and therapy[J]. Curr Diab Rep, 2015, 15(12): 118.
19	Patel SR, Malhotra A, Gottlieb DJ, et al. Correlates of long sleep duration[J]. Sleep, 2006, 29(7): 881-889.
20	Krueger PM, Friedman EM. Sleep duration in the United States: a cross-sectional population-based study[J]. Am J Epidemiol, 2009, 169(9): 1052-1063.
21	Whitaker KM, Lutsey PL, Ogilvie RP, et al. Associations between polysomnography and actigraphy-based sleep indices and glycemic control among those with and without type 2 diabetes: the Multi-Ethnic Study of Atherosclerosis[J]. Sleep, 2018, 41(11). DOI:10.1093/sleep/zsy172.
22	Buxton OM, Pavlova M, Reid EW, et al. Sleep restriction for 1 week reduces insulin sensitivity in healthy men[J]. Diabetes, 2010, 59(9): 2126-2133.
23	Buxton OM, Cain SW, O'Connor SP, et al. Adverse metabolic consequences in humans of prolonged sleep restriction combined with circadian disruption[J]. Sci Transl Med, 2012, 4(129): 129ra43.
24	Bakour C, Schwartz S, O'Rourke K, et al. Sleep duration trajectories and systemic inflammation in young adults: results from the national longitudinal study of adolescent to adult health (add health)[J]. Sleep, 2017, 40(11). DOI:10.1093/sleep/zsx156.
25	Mullington JM, Simpson NS, Meier-Ewert HK, et al. Sleep loss and inflammation[J]. Best Pract Res Clin Endocrinol Metab, 2010, 24(5): 775-784.
26	Joussen AM, Poulaki V, Le ML, et al. A central role for inflammation in the pathogenesis of diabetic retinopathy[J]. FASEB J, 2004, 18(12): 1450-1452.
27	Faraut B, Boudjeltia KZ, Vanhamme L, et al. Immune, inflammatory and cardiovascular consequences of sleep restriction and recovery[J]. Sleep Med Rev, 2012, 16(2): 137-149.
28	Bain AR, Weil BR, Diehl KJ, et al. Insufficient sleep is associated with impaired nitric oxide-mediated endothelium-dependent vasodilation[J]. Atherosclerosis, 2017, 265: 41-46.
29	Stockelman KA, Bain AR, Dow CA, et al. Regular aerobic exercise counteracts endothelial vasomotor dysfunction associated with insufficient sleep[J]. Am J Physiol Heart Circ Physiol, 2021, 320(3): H1080-H1088.
30	Hikichi T, Tateda N, Miura T. Alteration of melatonin secretion in patients with type 2 diabetes and proliferative diabetic retinopathy[J]. Clin Ophthalmol, 2011, 5: 655-660.
31	Nedeltcheva AV, Kilkus JM, Imperial J, et al. Insufficient sleep undermines dietary efforts to reduce adiposity[J]. Ann Intern Med, 2010, 153(7): 435-441.
32	Ida S, Kaneko R, Imataka K, et al. Are diabetes-related factors associated with the social roles of elderly patients with diabetes?[J]. J Diabetes Complications, 2021, 35(1): 107759.
33	Öztürk ZA, Yesil Y, Kuyumcu ME, et al. Association of depression and sleep quality with complications of type 2 diabetes in geriatric patients[J]. Aging Clin Exp Res, 2015, 27(4): 533-538.
34	Leong WB, Jadhakhan F, Taheri S, et al. Effect of obstructive sleep apnoea on diabetic retinopathy and maculopathy: a systematic review and meta-analysis[J]. Diabet Med, 2016, 33(2): 158-168.

Study	Country	Sample size	Mean age/ year	Exposure assessment	Sleep duration /h	Outcome	Outcome assessment	Adjusted variable	NOS score
Meng^［9］， 2016	China	1 220	57.78±10.41（DR present） 55.75±11.72（DR absent）	Self-report	Short （<6 ） Long （>9）	Any DR	Indirect ophthalmoscopy Retinal photographs	Gender， age， duration of diabetes， smoking history， BMI， SBP， HbA1c and dyslipidemia	7
Jee^［10］， 2017	Korean	1 670	60.3	Self-report	Short （≤5） Long （≥9）	Any DR VTDR	Retinal photographs	Gender， age， BMI， diabetes duration， fasting glucose level， HbA1c and hypertension	7
Chew^［11］， 2020	Singapore	92	57.6±8.3	Self-report	Short （<5 ）	Moderate DR VTDR	Retinal photographs	Age， gender， duration of diabetes	7
Raman^［12］，2012	India	1 414	M： 56.9±10.5	Self-report	Short （<5）	Any DR	Retinal photographs	Not mentioned	6
Raman^［12］，2012	India	1 414	F： 56.4±8.9	Self-report	Long （>9）	Any DR	Retinal photographs	Not mentioned	6
Tan^［13］， 2018	Malay India	1 231（Malaysian， 395；Indian， 836）	64.4±9.0	Self-report	Short （<6） Long （≥8）	Moderate DR VTDR	Retinal photographs	Age， gender， ethnicity， education， antihypertensive medication， current smoking， respiratory disorders， mood-related complaints， obesity， systolic and diastolic blood pressure， HbA1c， total cholesterol， low-density lipoprotein cholesterol， duration of diabetes， insulin use	9

Study	Country	Sample size	Mean age/ year	Exposure assessment	Sleep duration /h	Outcome	Outcome assessment	Adjusted variable	NOS score
Meng^［9］， 2016	China	1 220	57.78±10.41（DR present） 55.75±11.72（DR absent）	Self-report	Short （<6 ） Long （>9）	Any DR	Indirect ophthalmoscopy Retinal photographs	Gender， age， duration of diabetes， smoking history， BMI， SBP， HbA1c and dyslipidemia	7
Jee^［10］， 2017	Korean	1 670	60.3	Self-report	Short （≤5） Long （≥9）	Any DR VTDR	Retinal photographs	Gender， age， BMI， diabetes duration， fasting glucose level， HbA1c and hypertension	7
Chew^［11］， 2020	Singapore	92	57.6±8.3	Self-report	Short （<5 ）	Moderate DR VTDR	Retinal photographs	Age， gender， duration of diabetes	7
Raman^［12］，2012	India	1 414	M： 56.9±10.5	Self-report	Short （<5）	Any DR	Retinal photographs	Not mentioned	6
Raman^［12］，2012	India	1 414	F： 56.4±8.9	Self-report	Long （>9）	Any DR	Retinal photographs	Not mentioned	6
Tan^［13］， 2018	Malay India	1 231（Malaysian， 395；Indian， 836）	64.4±9.0	Self-report	Short （<6） Long （≥8）	Moderate DR VTDR	Retinal photographs	Age， gender， ethnicity， education， antihypertensive medication， current smoking， respiratory disorders， mood-related complaints， obesity， systolic and diastolic blood pressure， HbA1c， total cholesterol， low-density lipoprotein cholesterol， duration of diabetes， insulin use	9

[1]	王毅, 程诚, 沈红艳, 高红艳, 戴悦宁, 易正辉. 经颅磁刺激对阿尔茨海默病患者认知功能及伴痴呆的行为精神症状疗效的meta分析[J]. 上海交通大学学报(医学版), 2021, 41(7): 931-941.
[2]	王韩影, 蒋炎, 王晴仪, 石新, 牛田, 邢馨丹, 沈胤忱, 陈翀, 刘堃. 光学相干断层扫描血管成像技术观察糖尿病性视网膜病变及糖尿病性黄斑水肿患者视网膜血流变化[J]. 上海交通大学学报(医学版), 2021, 41(2): 166-172.
[3]	陈智灵, 罗晨, 赵康佳, 沈玲, 胡三莲. 2种镇痛方式在结直肠癌术后应用效果的meta分析[J]. 上海交通大学学报(医学版), 2021, 41(10): 1344-1350.
[4]	潘胜珂，李惠，魏燕燕，姚培芬，李华芳. 安慰剂治疗原发性失眠症患者的meta分析[J]. 上海交通大学学报（医学版）, 2020, 40(4): 505-.
[5]	黄燕1，张宪高2，林亨1，程淑英1. 重复经颅磁刺激对精神分裂症疗效及安全性研究的meta分析[J]. 上海交通大学学报（医学版）, 2020, 40(1): 81-.
[6]	洪波，何海宁，刘园园，苏宁，严峰，史琰琛，王静华，王涛，肖世富. 认知功能正常老人睡眠与认知功能变化1年随访研究[J]. 上海交通大学学报（医学版）, 2019, 39(9): 1017-.
[7]	余奇 1, 2，刘梦雪 3，杨杰 3，刘堃 1, 2，许迅 1, 2. 标准七视野眼底彩色照相中微动脉瘤病灶自动化识别研究[J]. 上海交通大学学报（医学版）, 2019, 39(6): 598-.
[8]	汪也微，陈艳，方新宇，张毅，蔡军，宋立升，张晨. 奥氮平血药浓度与细胞色素P450 1A2基因多态性关系的meta分析[J]. 上海交通大学学报（医学版）, 2019, 39(10): 1167-.
[9]	王青，姜达君，贾伟涛. Pauwels三型股骨颈骨折不同内固定方式的 meta分析[J]. 上海交通大学学报（医学版）, 2018, 38(9): 1045-.
[10]	沈杭启，许迅. 超广角眼底成像在糖尿病性视网膜病变中的诊疗价值及应用进展[J]. 上海交通大学学报（医学版）, 2018, 38(7): 793-.
[11]	彭林丽，王宏，何芳，程绪婷，王翎懿，蒋佳佳 . 男生首次遗精年龄与体力活动和睡眠时间的关系研究[J]. 上海交通大学学报（医学版）, 2017, 37(03): 394-.
[12]	初菁菁，冶超，金雯，殷希. 机器人辅助与传统模式腹腔镜下前列腺根治性切除术的meta分析[J]. 上海交通大学学报（医学版）, 2017, 37(01): 64-.
[13]	何金龙，王云霁，胡鸿涛，廖仟，张维奕，范小平. 不同正颌术式对骨性Ⅲ类错患者上气道影响的meta分析[J]. 上海交通大学学报（医学版）, 2016, 36(10): 1467-.
[14]	杨富，陈兰，方芳，等. 肝移植术后多重耐药菌感染危险因素的系统评价[J]. 上海交通大学学报（医学版）, 2015, 35(7): 1015-.
[15]	黄霞，宋艳艳. 吸烟与阿尔茨海默病发病风险关联性——病例对照研究和横断面研究数据的系统分析[J]. 上海交通大学学报（医学版）, 2015, 35(6): 870-.