1h负荷血糖:评价阻塞性睡眠呼吸暂停患者血糖变化的更好指标?

One-hour post-load plasma glucose:a better indicator of glucose metabolism for obstructive sleep apnea?

目的探讨口服糖耐量试验中各时间点血糖评价阻塞性睡眠呼吸暂停(OSA)患者血糖状况的价值。方法 89例OSA患者经整夜多导睡眠监测后,次晨行标准口服葡萄糖耐量试验(OGTT),记录夜间睡眠结构参数、呼吸暂停低通气指数、最低、平均指氧饱和度以及5个时间点的血糖水平。以体质量指数(BMI)为指标分为肥胖(BMI≥28)和非肥胖(BMI<28)组,分析血糖与人体测量数据和睡眠、呼吸变量之间的相关性;多元线性回归模型评价各因素对肥胖和非肥胖OSA人群各时间点血糖的贡献。结果 OSA人群中1 h负荷血糖(1 hPG)升高的比例高于2 h负荷血糖(2hPG),分别为67.4%和41.6%(P<0.05)。1 hPG与颈围(r=0.245)、腹围(r=0.231)、收缩压(r=0.213)、舒张压(r=0.276)和AHI(r=0.324)呈正相关,与MSO2和LSO2呈负相关(r=-0.341,-0.387);P<0.05;校正年龄和肥胖指标后,仍与血氧成负相关。非肥胖亚组中1 hPG与OSA指标(AHI,N2,MSO2,LSO2)相关性更加显著(P<0.05);多元线性回归模型显示LSO2和N2期睡眠占比对1 hPG贡献最大(校正R2=0.349,P<0.001)。结论 OSA患者OGTT1 hPG较早出现异常变化,其值独立于肥胖因素与OSA相关性密切,可能是与OSA病情相关血糖变化的敏感指标。

Objective To assess the value of blood glucose at different time points in oral glucose tolerance test（OGTT）,particularly one-hour post load plasma glucose（1 hPG）,in evaluating glucose metabolism in adult patients with obstructive sleep apnea（OSA）.Methods Eighty-nine adultswith newly diagnosed OSA were analyzed retrospectively for sleep architecture assessed using polysomnography and glucose metabolism assessed by OGTT at different time points（0,30,60,120,and 180 min）.Pearson＇s correlatives and multiple linear regression models were established to investigate the correlations between glucose metabolism and other indices including sleep architecture,apnea hypopnea index（AHI）,mean and lowest oxygen saturation（MSO_2 and LSO_2） and obesity measurements.Results The majority（67.4%） of the patients had abnormal 1 hPG,and 41.6% had abnormal 2 hPG.1 hPG was positively correlated with neck circumference（r=0.245）,abdomen circumference（r=0.231）,systolic blood pressure（r=0.213）,diastolic blood pressure（r=0.276） and AHI（r=0.324）,and was negatively associated with MSO_2（r=-0.341） and LSO_2（r=-0.387）（all P〈0.05）.After controlling for age,BMI,neck and abdomen circumferences,1 hPG was found to inversely correlated with MSO_2（r=-0.253,P=0.032） and LSO_2（r=-0.311,P=0.008）.In nonobese OSA subgroup,1 hPG was significantly associated with OSA-related indices,and regression models showed that LSO_2 and N2 were the two most important contributors to 1 hPG（adjusted R2=0.349,P〈0.001）;plasma glucose at other time points did not show such correlations.Conclusions 1 hPG abnormality occurs earlier than 2 hPG in OSA patients.1 hPG is significantly associated with OSA independent of obesity and may serve as a better index for measuring OSA-related glucose disorder.