阻塞性睡眠呼吸暂停低通气综合征患者糖代谢异常的研究

Impaired glucose metabolism in patients with obstructive sleep apnea hypopnea syndrome

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者糖代谢异常的发生情况及与OSAHS严重程度的关系；短期持续气道正压（CPAP）通气治疗后，糖代谢异常是否会有所改善。方法监测214例OSAHS者的睡眠和糖代谢，对糖代谢异常者行CPAP通气治疗。结果糖代谢异常者OSAHS组88例（54．3％），对照组17例（32．7％）。Logistic回归分析显示，糖代谢异常与OSAHS相关。OSAHS患者[呼吸暂停低通气指数（AHI）≥10次／h]发生糖代谢异常的风险是普通人群的2．44倍（95％CI1．201～4．958）。7例患者行CPAP通气治疗，治疗前后血糖变化差异无统计学意义（P〉0．05）。结论OSAHS患者（AHI≥10次／h）糖代谢异常的发生率高，OSAHS是糖代谢异常的独立危险因素之一；超重和（或）肥胖在糖代谢异常的发生、发展中起主要作用，排除超重和（或）肥胖的干扰，OSAHS患者的血糖水平与AHI、最长呼吸暂停时间相关；短期CPAP通气治疗改善OSAHS患者糖代谢异常的效果不明显。

Objective To investigate the prevalence of impaired glucose-insulin metabolism in obstructive sleep apnea hypopnea syndrome （OSAHS） ; to examine the relation between severity of OSAHS and impaired glucose metabolism; and to evaluate the effectiveness of continuous positive airway pressure （CPAP） on impaired glucose metabolism. Methods A total of 214 patients who were free of diabetes at baseline underwent both nocturnal polysomnography （PSG） , and 2-h oral glucose-tolerance test, insulin and hemoglobin Ale test. CPAP treatment for glucose-insulin metabolism （ ＋ ） was given to OSAHS group after informed consent had been obtained. Results Eighty-eight patients and 17 patients with impaired glucose- insulin metabolism were found in OSAHS group and the control group respectively. Impaired glucose-insulin metabolism was present in 54. 3% of OSAHS group and 32. 7% of control group. Logistic regression analysis showed a significant positive correlation with OSAHS （ AHI ≥ 10 times/h ） and impaired glucose-insulin metabolism in all patients （ OR = 2. 440, 95% CI 1. 201-4. 958 ）. Plasma glucose level changes had no significant differences between before and after CPAP treatment （ P 〉 0. 05 ）. Conclusion OSAHS is associated with a high frequency of impaired glucose metabolism. The relationship between OSAHS and impaired glucose metabolism is independent of obesity. Longest apnea time （LAT） and AHI are important contributors to impaired glucose metabolism in OSAHS patients. Short-term CPAP therapy has no significant improvement on glucose metabolism in patients with OSAHS.