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. 2025 Apr 28:zwaf259.
doi: 10.1093/eurjpc/zwaf259. Online ahead of print.

Nocturnal hypoxemic burden is associated with incident major adverse cardiovascular events in patients with type 2 diabetes

Sarah Driendl  1 , Mathias Baumert  2 , Michael Arzt  1 , Klaus J Stark  3 , Jan Pec  1 , Frederick Sinha  1 , Lukasz Kmiec  4 , Florian Zeman  5 , Stefan Stadler  1
Affiliations

Nocturnal hypoxemic burden is associated with incident major adverse cardiovascular events in patients with type 2 diabetes

Sarah Driendl et al. Eur J Prev Cardiol. .

Abstract

Aims: Type 2 diabetes (T2D) prevalence is globally increasing and associated with cardiovascular disease. Whether oximetry-derived nocturnal hypoxemic burden (NHB) parameters are associated with incident major adverse cardiovascular events (MACE) in a population with T2D is not known.

Methods: Overnight oximetry data from patients enrolled in the DIACORE (DIAbetes COhoRtE) sleep-disordered breathing sub-study, a prospective German cohort study of patients with T2D, was analyzed. NHB as cumulative time spent below 90% oxygen saturation (T90) as well as its composition of T90 attributed to acute desaturations (T90desaturation) and non-specific drifts in oxygen saturation (T90non-specific) was assessed. MACE was defined as a composite outcome of myocardial infarction, stroke, and cardiovascular death. Cox hazard regression analyses adjusted for potential known risk factors for atherosclerosis were conducted.

Results: The analysis population consisted of 1255 participants (41% female, mean age 67 years, mean diabetes duration 9.6 years). After a median follow-up of 6.5 years, a MACE occurred in 149 (12%) patients. T90, but not apnea-hypopnea index, was significantly associated with an increased risk of incident MACE by 48% independently of other known risk factors for atherosclerosis (Quartile 4 vs. Q1-3 adjusted HR 1.48, 95% CI [1.04; 2.12], p=0.032). In particular, T90non-specific contributed to the elevated risk for incident MACE (Q4 vs. Q1-3 adjusted HR 1.62, 95% CI [1.14-2.30], p=0.007).

Conclusion: In the present study, NHB was associated with MACE in patients with T2D and can be easily measured using oximetry. Further investigations are warranted to establish T90 reduction as a clinically meaningful treatment target.

Keywords: cardiovascular disease; hypoxemia; hypoxemic burden; sleep apnea; type 2 diabetes.

Plain language summary

Nocturnal hypoxemia is common in patients with type 2 diabetes and is linked to the development of major adverse cardiovascular events like myocardial infarction, stroke, or cardiovascular death. It can easily be measured using pulse oximeter clip and may yield a simple prognostic tool for patients with type 2 diabetes.Night time spent below 90% oxygen saturation was associated with newly diagnosed major adverse cardiovascular events independently of other known risk factors for atherosclerosis, and especially non-specific drifts in oxygen saturation contributed to the elevated risk. These non-specific drifts are common in patients with obesity.In contrast, event-based measures of sleep-disordered breathing such as apnea-hypopnea index were not associated with incident major adverse cardiovascular events.

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