Sleep apnea and diabetes mellitus (DM) negatively impact cardiovascular health. One important indicator of cardiovascular health is the Ankle-Brachial Index (ABI). Either low ABI or high ABI are signs of peripheral vascular impairment. Impaired vascular health and DM, together, might provoke sleep apnea; however, information regarding these relationships is limited. Therefore, this study aimed to investigate the association between ABI, DM status, and severity of obstructive sleep apnea in people of Hispanic/Latino descent who are diverse in culture, environmental exposures, nativity, socioeconomic status, and disease burden. A cross sectional analysis from a multi-center epidemiologic study, Hispanic Community Health Study/Study of Latinos, was utilized and included 3779 participants (mean age 55.32 ± 7.67, females 57.9%). The sample was divided into 4 groups based on the American Diabetes Association diagnostic guidelines (no DM or DM), and the ABI status (normal and abnormal). Multiple linear regression analysis was used to determine the association of the four groups and other independent variables with severity of sleep apnea measured by apnea-hypopnea index. Kruskal-Wallis H test was used for comparisons between groups for the apnea-hypopnea index. The significant level was set at 0.01. There were significant differences between groups in the mean of apnea-hypopnea index (P < 0.001; no DM + normal ABI = 5.42 ± 9.66, no DM + abnormal ABI = 7.11 ± 11.63, DM + normal ABI = 10.99 ± 15.16, DM + abnormal ABI = 12.81 ± 17.80). Linear regression showed that DM and abnormal ABI were significantly associated with severe sleep apnea (β = 3.25, P = 0.001) after controlling for age, sex, BMI, income, education, alcohol use, cigarette use, hypertension or related medication, stroke and statin use. These findings suggest that people with DM and abnormal ABI were more likely to have high apnea-hypopnea index compared to the other groups. We observed gradual increasing in the severity of sleep apnea from low abnormality groups to high abnormality groups for Hispanic/Latino. Further work should elucidate the association of DM, abnormal ABI and sleep apnea with longer term outcomes, and replicate this work in different populations.

中文翻译：

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西班牙裔社区健康研究/拉丁裔研究 (HCHS/SOL) 数据库中踝臂指数、糖尿病和睡眠呼吸暂停之间的关联

睡眠呼吸暂停和糖尿病 (DM) 对心血管健康产生负面影响。心血管健康的一项重要指标是踝臂指数（ABI）。低 ABI 或高 ABI 都是周围血管损伤的迹象。血管健康受损和糖尿病一起可能会引发睡眠呼吸暂停；然而，有关这些关系的信息有限。因此，本研究旨在调查具有不同文化、环境暴露、出生、社会经济状况和疾病负担的西班牙裔/拉丁裔后裔的 ABI、DM 状况和阻塞性睡眠呼吸暂停严重程度之间的关系。利用多中心流行病学研究“西班牙裔社区健康研究/拉丁裔研究”的横断面分析，该研究纳入了 3779 名参与者（平均年龄 55.32 ± 7.67 岁，女性 57.9%）。根据美国糖尿病协会诊断指南（无 DM 或 DM）和 ABI 状态（正常和异常）将样本分为 4 组。使用多元线性回归分析来确定四组和其他自变量与通过呼吸暂停低通气指数测量的睡眠呼吸暂停严重程度的关联。Kruskal-Wallis H 检验用于比较呼吸暂停低通气指数的组间情况。显着性水平设定为0.01。呼吸暂停低通气指数平均值在各组之间存在显着差异（P < 0.001；无 DM + 正常 ABI = 5.42 ± 9.66，无 DM + 异常 ABI = 7.11 ± 11.63，DM + 正常 ABI = 10.99 ± 15.16，DM +异常 ABI = 12.81 ± 17.80)。线性回归显示，在控制了年龄、性别、BMI、收入、教育程度、饮酒、吸烟、高血压或相关药物、中风和他汀类药物的使用。这些发现表明，与其他群体相比，患有 DM 和 ABI 异常的人更有可能出现高呼吸暂停低通气指数。我们观察到西班牙裔/拉丁裔的睡眠呼吸暂停严重程度从低异常组到高异常组逐渐增加。进一步的工作应该阐明糖尿病、异常 ABI 和睡眠呼吸暂停与长期结果的关联，并在不同人群中重复这项工作。