阻塞性睡眠呼吸暂停综合征患者胰岛素敏感性的变化

Insulin sensitivity in obstructive sleep apnea syndrome

目的研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者胰岛素敏感性(IS)的变化。方法55例男性鼾症患者行整夜睡眠呼吸监测,放免法测定FIns、C-P水平,计算ISI和QUICKI观察患者IS变化。结果随呼吸紊乱指数(AHI)增加,OSAHS患者胰岛素抵抗(IR)和肥胖的程度越来越明显。多元逐步线性回归分析结果提示BMI、最低血氧饱和度和AHI是IS下降的独立危险因素。OS-AHS患者持续气道正压通气治疗1个月后IS无明显变化。结论严重呼吸紊乱常与肥胖、IR合并存在。睡眠呼吸紊乱可能是IR的独立危险因素。

Objective To determine the insulin sensitivity in obstructive sleep apnea/hypopnea syndrome（OSAHS）.Methods All-night sleep breath screenings were conducted in 55 snoring patients.The levels of fasting plasma insulin and C-peptide were measured by radioimmunoassay.Insulin sensitivity markers such as insulin sensitivity index（ISI）and quantitative insulin sensitivity check index（QUICKI）were calculated to indicate insulin resistance in OSAHS.Results Significant differences（all P〈0.01）of body mass index,neck circumference,waist hip ratio,minimum O2,fasting blood glucose,insulin,C-peptide,QUICKI,and ISI were compared between normal and OSAHS groups.Multivariable linear regression analyses revealed that AHI,minimum O2 and BMI were independently associated with worsening insulin resistance.Insulin sensitivity showed no significant improvement after one-month nasal continuous positive airway pressure（CPAP）ventilation in moderate and severe OSAHS.Conclusion Patients with severe sleep breath disturbance are often complicated with notable obesity and insulin resistance which are important risk factors for diabetes.Our findings suggest that hypoxemia associated with sleep-disordered breathing contributes independently to insulin resistance.