阻塞性睡眠呼吸暂停综合征对糖代谢异常的影响

Contribution of obstructive sleep apnea syndrome to the development of abnormal of glucose metabolism

目的研究阻塞性睡眠呼吸暂停低通气综合征（OSAHS）对胰岛素抵抗（IR）程度及糖代谢的影响。方法选择确诊无糖尿病病史的OSAHS患者58例，另选57例无糖尿病病史非OSAHS患者作为对照组，OSAHS组患者经多导睡眠监测仪8b睡眠监测，区分为中、重度OSAHS组51例，其中中度OSAHS组21例，重度OSAHS组30例；轻度OSAHS组7例。所有患者均行75g葡萄糖耐量试验，采用胰岛素稳定状态模式评估方法（HOMA）指数评估IR，比较不同组别HOMA指数及糖代谢紊乱发生情况。结果①OSAHS组的HOMA—IR明显高于非OSAHS组，OSAHS组平均和最低脉搏氧饱和度（SpO2）明显低于非OSAHS组，上述指标在两组间比较差异均有统计学意义（P〈0．05），HOMA—IR指数和AHI呈正相关，和最低SpO，存在负相关。②OSAHS组的糖代谢紊乱的发生率明显高于非OSAHS组，且随着OSAHS程度的加重，糖代谢紊乱的发生率明显增加（P〈0．01）。结论睡眠呼吸功能紊乱与胰岛素抵抗及糖代谢异常的发生有关，在OSAHS患者中，随着呼吸紊乱程度加重，IR加重，糖代谢紊乱的发生率明显增加。

Objective To study the influence of obstructive sleep apnea syndrome （OSAS）to the development of abnormal glucose metabolism and insulin insistence. Methods Fifty - eight OSAHS patient and 57 normal volunteers were measured by polysomnograpby during sleep and 75 g oral glucose tolerance test, then compared the homeostasis model assessment（HOMA） index and abnormal glucose me- tabolism frequency. Results （1）HOMA - IR of OSAHS group were significantly higher than that in the control group（ P 〈 0.05 ） , HOMA index were positively correlated with AHI and negatively correlated with the nocturnal lowest SpO2 respectively with statistical significance. （2）The frequency of abnormal glu- cose metabolism in OSAHS group were significantly higher than that in the control group（ P 〈 0. 01 ）. Conclusions The extent of respiratory disturbance is closely related with insulin resistance and abnormal glucose metabolism. Insulin resistance inclined and the frequency of abnormal glucose metabolismn more higher accompany with the respiratory disturbance increased in OSAHS.