nCPAP治疗对2型糖尿病合并OSAHS患者空腹血糖变化的影响

Effect of Treatment with nCPAP on the Fasting Plasma Glucose in Patients of Type 2 Diabetes with OSAHS

目的:探讨经鼻持续正压通气(nasal continuous positive airway pressure,nCPAP)对2型糖尿病(T2DM)合并阻塞性睡眠呼吸暂停低通气综合征(Obstructive sleep apnea hypopnea syndrome,OSAHS)患者空腹血糖(FPG)改善作用。方法:选取2016年1月-2018年1月在本院住院的94例T2DM,根据多导睡眠呼吸监测(PSG)分为轻度组(n=14)、中度组(n=31)、重度组(n=29)与非OSAHS组(n=20)。行PSG后比较四组Epwoah嗜睡量表(ESS)、FPG、空腹C肽、空腹胰岛素、糖化血红蛋白(HbA1c)及最低血氧饱和度(LSpO2)。对中、重度组进行nCPAP治疗,对比治疗前后FPG、空腹C肽、空腹胰岛素、HbA1c及LSpO2。结果:随着AHI增高,ESS、HbA1c、FPG与空腹胰岛素逐渐升高,四组ESS、HbA1c、FPG与空腹胰岛素比较,差异有统计学意义(P<0.05)。治疗后中、重度组FPG、空腹胰岛素及AHI均低于治疗前(P<0.05),而LSpO2高于治疗前(P<0.05)。结论:T2DM患者随着AHI的增高,FPG、空腹胰岛素有增高的趋势,胰岛功能下降。而nCPAP能改善2型糖尿病合并中重度OSAHS患者空腹血糖。

Objective:To investigate the effect of treatment with nasal continuous positive airway pressure(nCPAP)on the fasting plasma glucose(FPG)in patients of type 2 diabetes(T2 DM)with obstructive sleep apnea hypopnea syndrome(OSAHS).Method:94 cases of T2 DM hospitalized in our hospital from January 2016 to January 2018 were selected.According to polysomnography(PSG),they were divided into mild group(n=14),moderate group(n=31),severe group(n=29)and not OSAHS group(n=20).Epwoah sleepiness scale(ESS),FPG,fasting C peptide,fasting insulin,glycosylated hemoglobin(HbA1 c)and lowest oxygen saturation(LSpO2)of four groups were compared after PSG.The moderate and severe groups were treated with nCPAP,and FPG,fasting C peptide,fasting insulin,HbA1 c and LSpO2 were compared before and after treatment.Result:With the increase of AHI,ESS,HbA1 c,FPG and fasting insulin increased gradually,there were statistically significant differences between the four groups of ESS,HbA1 c,FPG and fasting insulin(P<0.05).After treatment,FPG,fasting insulin and AHI in the moderate and severe groups were lower than before treatment(P<0.05),while LSpO2 in the moderate and severe groups was higher than before treatment(P<0.05).Conclusion:With AHI increased,FPG,fasting insulin has an increasing trend in T2 DM patients,but the islet function decreased.The nCPAP can improve fasting plasma glucose in patients with type 2 diabetes mellitus with moderate to severe OSAHS.