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已发表论文
冠周脂肪衰减指数介导TyG指数与2型糖尿病患者OSA风险之间的关联
Authors Zhang M, Du H, Zhou Q, Yao Y, Li L
Received 9 October 2025
Accepted for publication 28 November 2025
Published 19 January 2026 Volume 2026:19 571891
DOI https://doi.org/10.2147/DMSO.S571891
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Rebecca Baqiyyah Conway
Mei Zhang,1 Haimei Du,1 Qin Zhou,2 Yaxin Yao,2 Linjuan Li1
1Department of General Medicine, Yan’an University Affiliated Hospital, Shaanxi, People’s Republic of China; 2Department of Endocrinology, Yan’an University Affiliated Hospital, Shaanxi, People’s Republic of China
Correspondence: Linjuan Li, Email juanzi_0724@163.com
Objective: The comorbidity of type 2 diabetes mellitus (T2DM) and obstructive sleep apnea (OSA) represents a significant public health challenge. We quantified the mediating role of the coronary fat attenuation index (FAI) in the association between the triglyceride-glucose (TyG) index and OSA risk, characterizing its nonlinear dynamics.
Methods: In this retrospective cross-sectional study, we assessed OSA risk using the STOP-Bang questionnaire in 420 patients with T2DM undergoing coronary computed tomography angiography, classifying scores as low-risk (< 3), intermediate-risk (3– 4), or high-risk (≥ 5). We measured pericoronary adipose tissue (PCAT)-FAI in three major epicardial coronary arteries (the right coronary artery, the left anterior descending artery, and the left circumflex artery) and in the culprit vessels. The TyG index was calculated using: ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Statistical associations were evaluated using multivariable logistic regression, restricted cubic splines (RCS), and PROCESS macro-mediated analyses.
Results: PCAT-FAI was significantly elevated in LAD, LCX, RCA, and culprit vessels in patients at intermediate or high OSA risk versus the low-risk group (all p < 0.05). After adjusting for age, sex, BMI, and medication, each 1-unit TyG increase conferred a 2.3-fold higher OSA risk (adjusted OR = 3.30, 95% CI [1.92, 5.67], p < 0.01). RCS revealed threshold effects: OSA risk increased nonlinearly when RCA-FAI exceeded − 80 Hounsfield units (HU). RCA-FAI mediated 11.78% of the TyG index–OSA association (p = 0.03).
Conclusion: RCA-FAI partially mediates the impact of TyG on OSA severity through nonlinear pathways. These findings elucidate PCAT inflammation as a mechanistic link in T2DM-OSA comorbidity, supporting the use of RCA-FAI ≥ − 80 HU screening for precision risk stratification.
Keywords: type 2 diabetes, obstructive sleep apnea, triglyceride-glucose index, fat attenuation index, mediation analysis
1Department of General Medicine, Yan’an University Affiliated Hospital, Shaanxi, People’s Republic of China; 2Department of Endocrinology, Yan’an University Affiliated Hospital, Shaanxi, People’s Republic of China
Correspondence: Linjuan Li, Email juanzi_0724@163.com
Objective: The comorbidity of type 2 diabetes mellitus (T2DM) and obstructive sleep apnea (OSA) represents a significant public health challenge. We quantified the mediating role of the coronary fat attenuation index (FAI) in the association between the triglyceride-glucose (TyG) index and OSA risk, characterizing its nonlinear dynamics.
Methods: In this retrospective cross-sectional study, we assessed OSA risk using the STOP-Bang questionnaire in 420 patients with T2DM undergoing coronary computed tomography angiography, classifying scores as low-risk (< 3), intermediate-risk (3– 4), or high-risk (≥ 5). We measured pericoronary adipose tissue (PCAT)-FAI in three major epicardial coronary arteries (the right coronary artery, the left anterior descending artery, and the left circumflex artery) and in the culprit vessels. The TyG index was calculated using: ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Statistical associations were evaluated using multivariable logistic regression, restricted cubic splines (RCS), and PROCESS macro-mediated analyses.
Results: PCAT-FAI was significantly elevated in LAD, LCX, RCA, and culprit vessels in patients at intermediate or high OSA risk versus the low-risk group (all p < 0.05). After adjusting for age, sex, BMI, and medication, each 1-unit TyG increase conferred a 2.3-fold higher OSA risk (adjusted OR = 3.30, 95% CI [1.92, 5.67], p < 0.01). RCS revealed threshold effects: OSA risk increased nonlinearly when RCA-FAI exceeded − 80 Hounsfield units (HU). RCA-FAI mediated 11.78% of the TyG index–OSA association (p = 0.03).
Conclusion: RCA-FAI partially mediates the impact of TyG on OSA severity through nonlinear pathways. These findings elucidate PCAT inflammation as a mechanistic link in T2DM-OSA comorbidity, supporting the use of RCA-FAI ≥ − 80 HU screening for precision risk stratification.
Keywords: type 2 diabetes, obstructive sleep apnea, triglyceride-glucose index, fat attenuation index, mediation analysis