持续气道正压通气对重度OSAHS患者糖代谢的影响及其相关性分析

Effect of continuous positive airway pressure on glucose metabolism of severe obstructive sleep apnea hypopnea syndrome and their relationship

目的探讨持续气道正压通气(CPAP)对未合并2型糖尿病的重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血糖及糖代谢相关成分水平的影响及其相关性分析。方法收集重度OSAHS患者232例,选取其中未被诊断为糖尿病的患者161例进行研究,将这些患者随机分为CPAP治疗组(n=85)和传统方法治疗组(n=76),治疗3月后观察治疗前后口服葡萄糖耐量试验(OGTT)、血清糖化血红蛋白(HbA1c)、空腹胰岛素等情况,并计算稳态模型胰岛素抵抗指数(HOMA-IR),比较组间差异。结果(1)治疗后,CPAP治疗组患者HbA1c、服糖后2小时血糖(2h-PG)均明显下降,与治疗前比较差异有统计学意义(P<0.05),HOMA-IR及空腹血糖(FPG))也出现不同程度下降,但差异无统计学意义(P>0.05);而传统方法治疗组患者,治疗前后相关指标均无显著改善(P>0.05)。同时,比较两组患者治疗后指标的变化,HbA1c及2h-PG的差异有统计学意义(P<0.05)。(2)相关分析也显示,在CPAP治疗组中,21例患者出现糖耐量减低好转,0例患者出现加重;而在传统治疗组中,有12例患者糖耐量减低好转,10例患者加重,差异有统计学意义(P=0.039,P<0.05)。结论CPAP治疗纠正了间歇低氧、睡眠结构紊乱,从而改善了未合并2型糖尿病的重度OSAHS患者血糖调节,延缓了2型糖尿病的发生,有一定临床意义。

Objective To observe the effect of continuous positive airway pressure therapy(CPAP)on glucose metabolism components of severe obstructive sleep apnea hypopnea syndrome(OSAHS)without type 2 diabetes mellitus(T2DM)and their relationship.Methods 161 severe OSAHS patients without T2DM were randomly divided into the CPAP treatment group(n=85)and the conservative treatment group(n=76).OGTT,glycated hemoglobin(HbA1c),fasting insulin(FINS),and insulin resistance index(HOMA-IR)were compared before and 3 months after therapy.Results 3 months after treatment,HbA1c and 2h-PG decreased in the CPAP group(P<0.05),but HOMA-IR and FPG decreased without significant difference(P>0.05).In the conservative treatment group,there was no significant difference after therapy(P>0.05).And the differences were statistically significant between the two groups after therapy in HbA1c and 2h-PG(P<0.05).In the CPAP treatment group,impaired glucose tolerance(IGT)reversed in 21 patients and IGT developed in none,whereas IGT reversed in 12 patients and IGT developed in 10 patients in the CT group(P=0.039,P<0.05).Conclusion CPAP treatment can significantly rectify chronic intermittent hypoxia and disorder of sleep structure,and improve the blood glucose metabolism which can delay the occurrence of T2DM for patients with severe OSAHS without T2DM.It has a certain clinical significance.