阻塞型睡眠呼吸暂停低通气综合征与颈动脉硬化、胰岛素抵抗的相关性研究

Study on the relationship between obstructive sleep apnea-hypopnea syndrome and carotid atherosclerosis,insulin resistance

[目的]探讨阻塞型睡眠呼吸暂停低通气综合征(OSAHS)与颈动脉内膜中层厚度(IMT)、胰岛素抵抗(IR)之间的关系。[方法]以在大连医科大学附属第二医院就诊,经多导睡眠初筛仪检测,睡眠呼吸暂停低通气指数(AHI)≥5次/h的31例患者作为研究对象。选择同期在本院就诊,经多导睡眠初筛仪检测AHI<5次/h的31例患者作为对照组。两组受试对象性别比、年龄、血压、BMI、TC分布差异显著性意义(均P>0.05)。比较两组患者的稳态模型胰岛素抵抗指数(HOMA-IR)和颈动脉IMT的差异。再分别对HOMA-IR及颈动脉IMT与AHI、呼吸暂停及低通气的总时间、夜间最低脉搏血氧饱和度(SpO2)、平均SpO2进行Spearman相关分析。并分别以HOMA-IR及颈动脉IMT为因变量,以年龄、体重指数(BMI)、总胆固醇(TC)、AHI、夜间最低SpO2、呼吸暂停及低通气的总时间为自变量,进行多元逐步回归分析。[结果]与正常对照组相比,OSAHS组患者的HOMA-IR及颈动脉IMT明显增高(均P<0.05)。Spearman相关分析显示颈动脉IMT及HOMA-IR均与AHI、呼吸暂停及低通气的总时间呈正相关,与夜间最低SpO2呈负相关。多元逐步回归分析显示,影响IMT的因素依次是夜间最低SpO2、AHI、年龄、呼吸暂停及低通气的总时间。影响HOMA-IR的因素依次是夜间最低SpO2、BMI、AHI、呼吸暂停及低通气的总时间。[结论]OSAHS是引起颈动脉硬化及胰岛素抵抗的危险因素,改善OSAHS患者的低氧血症对防治动脉粥样硬化及胰岛素抵抗有重要意义。

[Objective] To discuss the relationship between obstructive sleep apnea- hypopnea syndrome （OSAHS） and carotid intima -media thickness （IMT）, insulin resistance （IR）. [ Methods] All subjects were selected from the patients attending the second Affiliated Hospital of Dalian Medical University. After test by portable polysomnograph, patients whose sleep apnea -hypopnea index （AHI） ≥5 times/h （31 patients） were included in the research group. During the same period, patients whose AHI 〈 5 times/h （31 patients） were included in the control group. There were no significant differences between sex ratio, age, BMI, TC of the two groups （ P 〉 0.05 ）. Then the comparison of difference was made between HOMA - IR and carotid IMT of the 2 groups. The relativity between HOMA - IR, carotid IMT and AHI, total time of apne a and hypopnea, the lowest SpO2, average SpO2 were respectively assessed by Spearman correlation test. Carotid IMT and HOMA- IR were respectively chosen as the dependent variables, and age, body mass index （BMI）, total cholesterol （TC） , AHI, the lowest SpO2 , total time of apnea and hypopnea were chosen as the independent variables for multiple stepwise regression analysis. [ Results] Compared with the normal group, HOMA - 1R and carotid IMT in OSAHS group increased significantly（ P 〈 0.05 ）. Spearman correlation analysis revealed that carotid IMT and HOMA -IR were both associated positively with AHI, total time of apnea and hypopnea, while they were both associated negatively with the lowest SpO2. Multiple stepwise regression analysis revealed that factors influencing IMT were the lowest SpO2 , which was followed by AHI, age, total time of apnea and hypopnea. Factors influencing HOMA - IR were the lowest SpO2, which was followed by BMI, AHI, total time of apnea and hypopnea. [ Conclusions] OSAHS is a risk factor of carotid artherosclerosis and insulin resistance. Treatment of hypoxemia has important role in preventing carotid artherosclerosis and insulin resistance.