阻塞性睡眠呼吸暂停低通气综合征胰岛素抵抗的危险因素分析

Analysis on risk factors of insulin resistance 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)患者发生胰岛素抵抗(IR)的危险因素。方法:选择行多导睡眠监测(PSG)的患者390例,其中确诊为OSAHS者365例,单纯鼾症者25例,依据HOMA-IR将OSAHS患者分为IR组(175例)和非IR组(190例),分析两组间一般资料及PSG监测结果的差异。结果:OSAHS患者的IR发生率(47.9%)高于单纯鼾症者(16.0%)(P=0.002)。与非IR组相比,IR组OSAHS患者的体重、体质指数、腰围、ESS评分、高血压病发病率、呼吸暂停低通气指数、血氧饱和度低于90%所占的时间比(CT90%)、氧减指数(ODI)、微觉醒指数、总呼吸暂停时间均升高,年龄、最低血氧饱和度、平均血氧饱和度均降低(P<0.05);logistic回归分析显示总呼吸暂停时间、CT90%、ODI、高血压病史是IR的危险因素,OR(95%CI)分别为1.037(1.023~1.052)、1.014(1.002~1.027)、1.007(1.004~1.011)、10.236(5.946~17.623)。结论:OSAHS与IR关系密切;总呼吸暂停时间、CT90%、ODI、高血压病史可能是OSAHS患者IR的危险因素。

Aim:To analyze the risk factors of insulin resistance(IR)in patients with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods:A total of 390 cases accepted polysomnography(PSG)were collected,among whom,365 cases were diagnosed with OSAHS,and 25 cases were diagnosed with simple snoring.OSAHS patients were divided into IR group(175 cases)and non-IR group(190 cases)according to HOMA-IR.The differences of general data and PSG results of the two groups were analyzed.Result:The incidence of IR in OSAHS patients(47.9%)was significantly higher than that in patients with simple snoring(16.0%)(P=0.002).Compared with the non-IR group,body weight,body mass index,waist circumference,ESS score,hypertension incidence,apnea hypopnea index,time ratio of blood oxygen saturation lower than 90%(CT90%),oxygen desaturation index(ODI),microarousal index,and total apnea time of the IR group increased significantly,while age,the lowest oxygen saturation and mean oxygen saturation decreased significantly(P<0.05).Logistic regression analysis showed that total apnea time,CT90%,ODI,and history of hypertension were risk factors of IR,and OR(95%CI)were 1.037(1.023-1.052),1.014(1.002-1.027),1.007(1.004-1.011),10.236(5.946-17.623),respectively.Conclusion:OSAHS is closely related to IR.Total apnea time,CT90%,ODI,history of hypertension may be risk factors for IR in OSAHS patients.