持续气道正压通气对阻塞性睡眠呼吸暂停低通气综合征合并2型糖尿病患者24 h动态血糖的影响

目的 评估短期持续气道正压通气(CPAP)对阻塞性睡眠呼吸暂停低通气综合征合并糖尿病(OWD)患者24 h动态血糖水平的影响.方法 OWD患者11例,年龄43～70(56±10)岁,体重指数22.3～38.3(28.5±5.5)ks/m~2,呼吸暂停低通气指数12～68(45±23)次/h.应用动态血糖监测系统(CGMS)连续进行动念血糖监测6 d,后4 d每夜给予CPAP治疗.比较治疗前后患者全天24 h、治疗时段(6 h,0:00-6:00)和非治疗时段(18 h)的血糖水平及平均血糖波动幅度(MAGE).CPAP治疗前和治疗2 d后晨起6时测定空腹血糖(FBG)、空腹FINS,以稳态模型分析法评估稳态模型的胰岛素抵抗指数(HOMA-IR).结果 CPAP治疗后,24 h和治疗时段动态血糖水平以及24 h、治疗时段和非治疗时段MAGE均明显低于治疗前(7.97±1.31)比(7.52±0.94)mmol/L,(7.24±1.51)比(6.77±1.65)mmol/L,1.22±0.34比0.89 ±0.28,0.43 ±0.24比0.31 ±0.18,1.23±0.89比0.49±0.26,均P＜0.05),HOMA-IR也明显低于治疗前(3.65±1.93比2.79±1.68,P＜0.05).结论短期CPAP治疗有助于改善OWD患者24 h血糖水平、血糖波动幅度和胰岛索抵抗.

Effect of continuous positive airway pressure upon 24 h changes of blood glucose level in patients with obstructive sleep apnea hypopnea syndrome and type 2 diabetes

Objective To assess the effect of short-term continuous positive airway pressure (CPAP)upon 24 h glucose control via a continuous glucose monitoring system(CGMS)in patients with obstructive sleep apnea hypopnea syndrome and type 2 diabetes(OWD). Methods Eleven cases of hospitalized OWD with age 43-70(56±10)years old, body mass index 22.3-38.3(28.5 ±5.5)kg/m~2 and apnea hypopnea index(AHI)12～68(45 ±23)times/h was recruited. CGMS was applied 2 days before and 4 days during CPAP treatment The 24 h. Treatment hours(6 h. 0: 00-6: 00)and nontreatment hours(18 h)glucose level and glucose variability were analyzed. Insulin resistance was assessed with fasting plasma blood glucose(FBG), plasma insulin(FINS)and homeostatic model assesment of insulin resistance index(HOMA-IR). Results Short-term CPAP treatment corrected sleep disordered breathing, and induced significant decreases of 24 h and treatment hours blood glucose level (7.97±1.31)vs(7.52 ±0.94)mmol/L, (7.24±1.51)vs(6.77±1.65)mmol/L, both P＜0.05). Glucose variability of 24 h and treatment hours and non-treatment hours significantly decreased after CPAP treatment (1.22±0.34 vs 0.89 ±0.28, 0.43±0.24 vs 0.31 ±0.18, 1.23±0.89 vs 0.49 ±0.26, all P＜0.05). Short-term treatment also induced increase of insulin sensitivity, as indicated by a significant decrease of HOMA-IR(3.65±1.93 vs 2.79 ±1.68, P＜0.05). Conclusion Short-term CPAP treatment in OWD may have an improving effect not only upon insulin resistance but also upon whole-day blood glucose and glucose variability.