OSAS代谢紊乱特征及其与胰岛素抵抗的关系

Metabolic profile and insulin resistance in patients with OSAS

目的探讨阻塞性睡眠呼吸暂停综合征（OSAS）的代谢紊乱特征及其与胰岛素抵抗的关系。方法54例男性OSAS患者，应用多导睡眠描记仪（PSG）进行睡眠呼吸监测，根据呼吸暂停低通气指数（AHI）分为OSAS重度组（n=39，AHI〉40次／h）和非重度组（n=15，AHI5～40次／h）。患者分别测量体质参数、空腹血糖、胰岛素、血脂及CT腹部脂肪面积等指标。结幂OSAS患者的胰岛素抵抗指数（HOMA—IR）与缺氧相关，且独立于肥胖指标。重度OSAS患者代谢综合征的异常程度及发生率明显高于非重度组，其发病风险为非重度组的8．8倍。以体质量指数、颈围为自变量，绘制代谢综合征的ROC曲线，腰围的曲线下面积最大。制作睡眠监测时最低氧饱和度（LSpO2）的逐步回归模型，颈围和Epworth嗜睡量表（ESS）评分先后进入回归方程，二者对LSpO2均有显著性影响（均P〈0．05）。结论OSAS是胰岛素抵抗的独立危险因素，腰围和颈围分别是预测OSAS代谢综合征和缺氧严重程度最简易的指标。

Objective To investigate the metabolic profile and its relationship with insulin resistance in patients with obstructive sleep apnea-hypopnea syndrome （OSAS）. Methods Fifty-four male patients with OSAS were enrolled and performed polysomnography （PSG）. According to the apnea hypopnea index （AHI） , all the patients were grouped into OSAS severe group （n = 39, AHI 〉 40/h） and non-severe group（n =15, AHI 5-40/h）. Anthropometric measurements, fasting plasma glucose, insulin, blood fat, and CT quantitative measurement of abdominal adipose tissue were recorded. Results Insulin resistance index （HOMA-IR） in patients with OSAS was related to hypoxia independently of obesity variables. The severe group was characterized by more serious metabolic disorders and higher prevalence of metabolic syndrome than the non-severe group. OSAS was positively associated with an increased metabolic disorders risk for the severe group versus the non-severe group （ OR = 8.8）. Using the receiver operating characteristic （ROC） curve analysis, waist circumference had the greatest areas under the ROC curves compared with body mass index and neck circumference. The results of multiple stepwise regression of lowest pulse oxygen saturation （ LSpO2 ） during overnight sleep indicated that neck circumference followed by epworth sleepiness score （ESS） entered the equation （ P 〈 0.05）. Conclusion OSAS is an independent risk factor for insulin resistance. Waist circumference and neck circumference are the most simple indexes in predicting metabolic syndrome and hypoxia, respectively.