吸烟对OSA患者术后糖脂代谢及睡眠结构的影响  

Effect of smoking on glucose,lipid metabolism and sleep structure in postoperative patients with obstructive sleep apnea

作　　者：朱华明[1] 易红良[1] 关建[1] 邹建银[1] 许华俊[1] 刘玉璞[1] ZHU Huaming;YI Hongliang;GUAN Jian;ZOU Jianyin;XU Huajun;LIU Yupu(Department of Otolaryngology Head and Neck Surgery,Shanghai Jiao TongUniversity Affiliated Sixth People’s Hospital,Shanghai Key Laboratory of Sleep Disordered Breathing,and Otolaryngological Institute,Shanghai Jiao Tong University,Shanghai,200233,China)

机构地区：[1]上海交通大学附属第六人民医院耳鼻咽喉头颈外科上海市睡眠呼吸障碍疾病重度实验室上海交通大学耳鼻咽喉研究所,上海200233

出　　处：《临床耳鼻咽喉头颈外科杂志》2021年第2期146-151,共6页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：上海市科委研发基地专项项目(No:18DZ2260200)。

摘　　要：目的:探讨吸烟对中重度阻塞性睡眠呼吸暂停(OSA)患者手术后糖脂代谢及睡眠结构的影响。方法:回顾性分析2016年1月-2017年12月诊治的103例成年男性中重度OSA患者,均无法耐受持续正压通气,经耳鼻咽喉科医师评估后接受了改良悬雍垂腭咽成形术。纳入研究的患者以是否吸烟分为吸烟组和不吸烟组。所有患者均进行整夜PSG监测、人体生理学数据测量、血液生化检查(包括血糖、血脂),在术前进行问卷填写,包括吸烟的问卷调查、Epworth嗜睡量表(ESS)等。术后6个月以后复查,记录上述所有的数据资料。手术前后各项指标的变化量以Δ表示(Δ=术后数值-术前数值)。结果:OSA中度15例,重度88例。治愈19例(18.4%),显效24例(23.3%),有效14例(13.6%),总体有效57例(55.3%)。不吸烟组与吸烟组的手术有效率差异无统计学意义(59.7%vs.48.9%,P=0.276)。所有患者术后AHI、SaO2、氧减指数、MAI、总胆固醇(TC)、空腹血糖(FINS)、空腹胰岛素(HOMA-IR)、BMI、ESS及N1、N3期睡眠占总睡眠时间的比例均较术前明显改善(P<0.05)。不吸烟组与吸烟组间的ΔTC、ΔTG、ΔHDH-C、ΔLDL-C、ΔFINS、ΔHOMA-IR等代谢指标均差异无统计学意义(P>0.05);但在睡眠结构方面,不吸烟组的ΔN3期睡眠改善的程度高于吸烟组(P=0.039)。结论:上气道手术有助于改善OSA患者的糖脂代谢紊乱及睡眠结构;吸烟对术后糖脂代谢的影响作用不明显,但对睡眠结构有影响,不吸烟的OSA患者,术后睡眠结构的改善优于吸烟者。Objective:The aim of this study is to investigate the effect of smoking on the glucose,lipid metabolism and sleep structure in patients with moderate and severe obstructive sleep apnea(OSA)after operation.Methods:A retrospective analysis of 103 adult male patients with moderate to severe OSA who were diagnosed and treated from January 2016 to December 2017.All of them could not tolerate continuous positive pressure ventilation.After evaluation by an otolaryngologist,they underwent modified uvulapalatopharyngoplasty surgery.All participants were grouped according to smoking status(non-smokers,smokers)for analysis.Laboratory-based polysomnographic variables,anthropometric measurements,biochemical indicators,and smoking history,Epworth sleepiness score(ESS)were collected preoperatively and postoperatively.And the difference of each variable preoperatively and postoperatively was demonstrated as delta(Δ,calculated as postoperative value minus preoperative value).Results:Fifteen patients with preoperative moderate OSA and 88 patients with severe OSA.The overall successful rate of surgery was 55.3%(18.4%cured,23.3%markedly effective and 13.6%effective),and there was no statistical difference between the non-smokers and the smokers(59.7%vs 48.9%,P=0.276).After surgery,AHI,mean oxygen saturation,ODI,MAI,TC,FBG,fasting insulin,BMI,ESS,N1 and N3 were significantly improved(P<0.05).The amelioration of glucose or lipid metabolism related traits(includingΔTC,ΔFBG,Δfasting insulin)were not significantly different between smokers and non-smokers.However,as to sleep structure,ΔN3 was significantly higher in non-smoker as compared to smokers(P=0.039).Conclusion:Upper airway surgery is helpful to improve the glucose and lipid metabolism disorder and sleep structure in OSA patients.Postoperative smoking was associated with worse sleep structure,but not glycolipid metabolism.The postoperative improvement of sleep structure in non-smoking OSA patients was better than smokers.

关 键 词：睡眠呼吸暂停 阻塞性 吸烟 糖脂代谢 睡眠结构 上气道手术 

分 类 号：R766[医药卫生—耳鼻咽喉科]