[阻塞性睡眠呼吸暂停患者的代谢异常]
[Metabolic abnormalities in obstructive sleep apnea patients].
作者信息
Czerniawska Justyna, Bieleń Przemysław, Pływaczewski Robert, Czystowska Monika, Korzybski Damian, Sliwiński Paweł, Górecka Dorota
机构信息
II Klinika Chorób Płuc Instytutu Gruźlicy i Chorób Płuc w Warszawie Kierownik.
出版信息
Pneumonol Alergol Pol. 2008;76(5):340-7.
INTRODUCTION
Obstructive sleep apnea (OSA) is a well-recognized risk factor of cardiovascular disorders and is related to metabolic syndrome. The aim of this study was to evaluate the effect of BMI and AHI/RDI on metabolic disturbances in patients suspected of OSA.
MATERIAL AND METHODS
Ninety-nine patients referred with suspected OSA underwent standard polysomnography or limited sleep study. AHI/RDI > or = 10/hour was considered relevant for OSA diagnosis. Subjects with AHI/RDI < 10 were considered as controls. We assessed apnea-hypopnea index or respiratory disturbances index (AHI/RDI), Epworth sleepiness scale (ESS), body mass index (BMI), C-reactive protein (CRP, mg/l), glycosylated haemoglobin (HbA1c, %), fasting serum total cholesterol, HDL-, LDL-cholesterol, triglycerides (TG), glucose (G), insulin (INS, IU/ml) and HOMA index.
RESULTS
Data are presented as mean +/- SD or median (interquartile range) for parametric and nonparametric data respectively. Twenty-two patients were included as controls (age 51.8 +/- 10 vs. 55 +/- 11 in OSA; p = NS). AHI/RDI in the OSA group was 23 (16-31.3) and 7 (3.8-8.1) in controls (p < 0.001). BMI in OSA 32.2 +/- 5.8 vs. 30.4 +/- 4.6 in controls (p = NS). Patients with OSA had higher TG (160 +/- 75.9 vs. 130.2 +/- 51.9 mg/dl, p = 0.046), G (5.04 +/- 0.6 vs. 4.47 +/- 0.6, p = 0.0037), HOMA (2.31 +/- 1.5 vs. 1.85 +/- 1.7, p = 0.046). G correlated best with AHI/RDI (p < 0.001, r = 0.41). Significant differences were observed in OSA patients between obese (51 pts, BMI 35.2 +/- 4.8) and non-obese (26 pts, BMI 26.61 +/- 1.9) pts in: HDL-cholesterol (50.8 +/- 13.2 vs. 60.9 +/- 18.4 mg/dl; p = 0.02), TG (178.7 +/- 69.9 vs. 124 +/- 75.3 mg/dl, p < 0.001), G (5.15 +/- 0.7 vs. 4.8 +/- 0.5 mmol/l, p = 0.01), INS (11.7 +/- 5.9 vs. 6.57 +/- 4.7, p < 0.001), HOMA (2.7 +/- 1.4 vs. 1.4 +/- 1.2, p < 0.001), HbA(1c) (5.89 +/- 0.9 vs. 5.4 +/- 0.8, p = 0.03), CRP (2.2 +/- 2.9 vs. 1.09 +/- 1.2, p = 0.01).
CONCLUSIONS
Our findings support the results of previous studies showing the influence of OSA alone on metabolic disturbances. However, BMI has major impact on metabolic variables.
引言
阻塞性睡眠呼吸暂停（OSA）是一种公认的心血管疾病风险因素，与代谢综合征相关。本研究的目的是评估体重指数（BMI）和呼吸暂停低通气指数/呼吸紊乱指数（AHI/RDI）对疑似OSA患者代谢紊乱的影响。
材料与方法
99例疑似OSA患者接受了标准多导睡眠图检查或有限睡眠研究。AHI/RDI≥10次/小时被认为与OSA诊断相关。AHI/RDI<10的受试者被视为对照组。我们评估了呼吸暂停低通气指数或呼吸紊乱指数（AHI/RDI）、爱泼沃斯嗜睡量表（ESS）、体重指数（BMI）、C反应蛋白（CRP，mg/l）、糖化血红蛋白（HbA1c，%）、空腹血清总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、甘油三酯（TG）、血糖（G）、胰岛素（INS，IU/ml）和稳态模型评估指数（HOMA）。
结果
参数数据和非参数数据分别以均值±标准差或中位数（四分位间距）表示。22例患者被纳入对照组（年龄51.8±10岁，OSA组为55±11岁；p=无显著性差异）。OSA组的AHI/RDI为23（16 - 31.3），对照组为7（3.8 - 8.1）（p<0.001）。OSA组的BMI为32.2±5.8，对照组为30.4±4.6（p=无显著性差异）。OSA患者的TG（160±75.9 vs. 130.2±51.9 mg/dl，p=0.046）、G（5.04±0.6 vs. 4.47±0.6，p=0.0037）、HOMA（2.31±1.5 vs. 1.85±1.7，p=0.046）更高。G与AHI/RDI的相关性最佳（p<0.001，r=0.41）。在OSA患者中，肥胖患者（51例，BMI 35.2±4.8）和非肥胖患者（26例，BMI 26.61±1.9）在以下方面存在显著差异：高密度脂蛋白胆固醇（50.8±13.2 vs. 60.9±18.4 mg/dl；p=0.02）、TG（178.7±69.9 vs. 124±75.3 mg/dl，p<0.001）、G（5.15±0.7 vs. 4.8±0.5 mmol/l，p=0.01）、INS（11.7±5.9 vs. 6.57±4.7，p<0.001）、HOMA（2.7±1.4 vs. 1.4±1.2，p<0.001）、HbA1c（5.89±0.9 vs. 5.4±0.8，p=0.03）、CRP（2.2±2.9 vs. 1.09±1.2，p=0.01）。
结论
我们的研究结果支持先前的研究结果，即单独的OSA对代谢紊乱有影响。然而，BMI对代谢变量有重大影响。
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