规范治疗老年人阻塞性睡眠呼吸暂停低通气综合征合并2型糖尿病的疗效  

pplication of standard treatment protocol for type 2 diabetes patients with obstructive sleep apnea hypopnea syndrome in the elderly

作　　者：张霄[1] 欧阳松云[1] 孙培宗[1] 陈瑞英[1] 代丽萍[3] 栗夏莲[2] 汪丽娟[2] 

机构地区：[1]郑州大学第一附属医院呼吸及睡眠科,450000 [2]郑州大学第一附属医院内分泌科,450000 [3]郑州大学公共卫生学院流行病学教研室

出　　处：《中华老年医学杂志》2013年第11期1141-1144,共4页Chinese Journal of Geriatrics

基　　金：基金项目：河南省科技厅重点攻关项目（122102310218）

摘　　要：目的评估以持续气道正压通气（CPAP）为主的规范治疗对老年人阻塞性睡眠呼吸暂停低通气综合征（OsAHs）合并2型糖尿病及胰岛素抵抗的疗效。方法将63例确诊为OSAHS合并2型糖尿病的老年患者随机分为CPAP组32例和对照组31例，对照组给予饮食控制、合理运动、降糖药物等常规治疗，CPAP组给予CPAP联合常规治疗的规范治疗，观察治疗后7d、1个月、3个月患者的空腹血糖（FBG）、口服葡萄糖耐量试验（OGTT）、胰岛素抵抗的体内稳态模型评估（HOMA—IR）指数、体质指数（BMI）、呼吸暂停低通气指数（AHI）、最低血氧饱和度（L-SaO2）和胰岛素每日应用量变化，治疗前和治疗后3个月查糖化血红蛋白（HbAlc）。结果CPAP组患者治疗后7dFBG、OGTT2h、HOMA—IR、AHI、胰岛素每日应用量明显降低，L—saO2显著升高；治疗后1个月BMI显著降低；治疗后3个月HbAlc明显降低。对照组L—SaOz随时间变化显著降低，治疗后3个月胰岛素每日应用量明显增加。治疗前两组各观察值差异均无统计学意义，除治疗后7d两组BMI差异无统计学意义外，两组治疗后各观察值差异均有统计学意义（均P〈0．05）。结论与单一的常规治疗方法比较，以CPAP为主的规范治疗对提高0sAHs合并2型糖尿病患者对胰岛素的敏感性、改善胰岛素抵抗更有效。Objective To evaluate the efficacy of continuous positive airway pressure （CPAP） - based standard treatment on obstructive sleep apnea-hypopnea syndrome （OSAHS） patients with type 2 diabetes and insulin resistance （IR） in the elderly. Methods 63 elderly type 2 diabetes patients diagnosed as OSAHS were randomly divided into control group （n= 31） and CPAP group （n=32）. Patients in control group were treated with conventional therapy including diet control, exercise and antidiabetic drugs, and patients in CPAP group were treated with CPAP treatment combined with conventional therapy. Fasting glucose （FBG）, oral glucose tolerance test （OGTT）, homeostasis model assessment of IR index （HOMA-IR）, body mass index （BMI）, apnea-hypopnea index （AHI）, lowest oxygen saturation （L-SaO2） and the dosage of insulin application were observed after 7 days, 1 month, 3 months of the treatment. Glycosylated hemoglobin （HbAlc） was determined before and after 3 months of the treatment. Results In CPAP group, levels of FBG and 2 h OGTT glucose, HOMA-IR, AHI, daily insulin dosage were significantly reduced and L-SaO2 was significantly increased after 7 days of the treatment; BMI was significantly reduced after 1 month of the treatment; HbAlc level was significantly reduced after 3 months of the treatment. In control group, L-SaOz was significantly reduced along with the multiple time points; daily insulin dosage was significantly increased after 3 months of the treatment. There were no significant differences in all observed indicators between groups before treatment. There were significant differences in the observed indicators between groups after treatment except for BMI after 7 days of the treatment.Conclusions Compared with conventional therapy, CPAP-based standard treatment has more efficacy on increasing insulin sensitivity and improving insulin resistance in elderly patients with OSAHS and type 2 diabetes.

关 键 词：睡眠呼吸暂停 阻塞性 糖尿病 2型 

分 类 号：R766[医药卫生—耳鼻咽喉科] R587.1[医药卫生—临床医学]