阻塞性睡眠呼吸暂停低通气综合征患者糖代谢状况的研究  

The impact of obstructive sleep apnea hypopnea syndrome on glucose metabolism

作　　者：冯媛[1] 郭东英 彭辉[2] 李丹青[1] 许婷[1] 庞礴[1] 蒋倩[1] 李涛平[1] 

机构地区：[1]南方医科大学南方医院睡眠医学中心,广州510515 [2]南方医科大学附属第三医院

出　　处：《中华内科杂志》2015年第8期691-694,共4页Chinese Journal of Internal Medicine

基　　金：国家十二五科技支撑计划（2012BAI05B03）;广东省科技计划项目（2011B090400378,面上项目2013）;南方医科大学南方医院院长基金（20132001）

摘　　要：目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）与糖代谢的关系，并分析其影响因素。方法选2010年1月1日-2011年6月30日南方医科大学南方医院睡眠医学中心的180例睡眠打鼾患者，其中OSAHS患者140例，非OSAHS患者40例。所有受试者接受多导睡眠监测和口服葡萄糖耐量试验（OGTT），测空腹血糖（FPG），分析不同呼吸暂停低通气指数（AHI）、最低脉搏血氧饱和度（SpO2）的患者间FPG、糖负荷后1h血糖（1hPG）、糖负荷后2h血糖（2hPG）差异。结果OSAHS患者糖尿病患病率为21．4％，高于非OSAHS患者（5．0％）；糖尿病前期患病率为34．3％，高于非OSAHS患者（25．0％）。不同AHI、不同最低SpO2的OSAHS患者FPG、1hPG、2hPG水平差异有统计学意义（P值均〈0．01）。校正颈围后，不同AHI患者1hPG、2hPG差异有统计学意义（P值均〈0．01）。相关分析：FPG、1hPG、2hPG与AHI（r分别为0．167、0．277、0．196，P值均〈0．05）、平均SpO2（r分别为-0．154、-0．214、-0．182，P值均〈0．05）、最低SpO2（r分别为-0．224、-0．231、-0．159，P值均〈0．05）相关；FPG、1hPG、2hPG与非快速动眼N1＋N2期睡眠、N3期睡眠及快速动眼期睡眠无显著相关（P值均〉0．05）。结论血糖状态与OSAHS的严重程度呈正相关。与FPG比，1hPG、2hPG受OSAHS的影响更大，且独立于肥胖。相对于睡眠结构和睡眠效率，睡眠低氧血症与糖代谢紊乱的相关性可能更大。Objective To study the influence of obstructive sleep apnea hypopnea syndrome （OSAHS） on glucose metabolism and comprehensively analyze its related factors. Methods A total of 180 snoring patients were recruited in Sleep Disorder Center of Nanfang Hospital of Southern Medical University between January 2010 to June 2011. There werel40 patients with OSAHS and 40 subjects without OSAHS. All patients underwent both a full polysomnography （PSG） and plasma glucose measure, including fasting plasma glucose （FPG） and oral glucose tolerance test （OGTT）. The FPG, 1-hour post-challenge glucose（lhPG） and 2-hour post-challenge glucose （2hPG） were respectively compared in patients with different apnea hypopnea index （AHI）, the lowest saturation of pulse oximetry （SpO2 ） and sleep architecture. Results The incidence of glucose metabolism disorders was higher in patients with OSAHS than that of those without （diabetes：21.4% vs 5.0% ; prediabetes：34. 3% vs 25.0% ）. The FPG, lhPG and 2hPG in patients with different AHI was significantly different respectively （ all P 〈 0. 01 ） , so as in patients with different lowest oxygen saturation （ all P 〈 0. 01 ） . Post-load glucose levels of patients with different AHI were still significantly different after adjustment for neck circumference （ 1 hPG ： P = 0. 004 ; 2hPG： P =0. 048）. FPG, lhPG and 2hPG were associated with AHI （r =0. 167,0. 277,0. 196, all P 〈 0. 05） , mean SpO2（r = -0. 154, -0. 214, -0. 182, all P 〈0. 05 ） and the lowest SpO2 （r = -0. 224,-0. 231, -0. 159, all P 〈 0. 05 ） ; While FPG, lhPG and 2hPG were not significantly associated with N1 ＋ N2, N3 and rapid eye movement （ REM ） sleeps （ all P 〉 0. 05 ）. Conclusions The risk of glucose metabolism disorders increased with the severity of OSAHS. Compared with fasting glucose, post-load glucose was more affected by OSAHS independent of obesity. Compared with sleep architecture or sleep efficiency, glucose metabolism disorders seem to be

关 键 词：睡眠呼吸暂停 阻塞性 血糖 血氧饱和度 睡眠结构 

分 类 号：R766[医药卫生—耳鼻咽喉科]