高血压合并阻塞性睡眠呼吸暂停综合征患者胰岛素抵抗临床分析

目的:探讨高血压合并阻塞性睡眠呼吸暂停综合征患者发生胰岛素抵抗(IR)情况。方法:采用回顾性研究方法,选择高血压患者93例,根据多导睡眠仪监测的结果,将合并阻塞性睡眠呼吸暂停综合征患者42例作为睡眠呼吸暂停组,单纯高血压患者51例作为高血压组,所入选的患者均行血生化检查。结果:(1)睡眠呼吸暂停组的收缩压、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、体质量、体质量指数(BMI)、颈围、腰围、臀围、腰臀比、空腹血糖(FPG)、2h血糖(2hPG)、空腹血胰岛素(FIns)和稳态模型胰岛素抵抗指数(HOMA-IR)均高于高血压组(P<0.05);(2)睡眠呼吸暂停组的呼吸暂停或低通气次数、呼吸暂停或低通气累计时间、AHI、平均血氧饱和度、夜间平均血氧饱和度、血氧饱和度<90%时间、血氧饱和度<90%缺氧事件总数、睡眠期间血氧饱和度<90%的时间占睡眠时间百分比均高于高血压组(P<0.01);(3)Pearson相关分析显示,IR与TC、TG、FIns、FPG、2hPG、体质量、BMI、颈围、腰围、臀围、腰臀比、呼吸暂停或低通气次数、呼吸暂停或低通气累计时间、AHI、血氧饱和度<90%时间和血氧饱和度<90%缺氧事件总数呈正相关,IR与夜间平均血氧饱和度呈负相关;(4)以IR为因变量行多元线性逐步回归分析,FIns、FPG、腰围和呼吸暂停或低通气累计时间是IR的独立影响因素。结论:高血压合并阻塞性睡眠呼吸暂停综合征患者的糖代谢异常和夜间缺氧可能参与IR。

Insulin resistance in hypertensive patients with obstructive sleep apnea-hypopnea syndrome

Objective:To investigate the status of insulin resistance in hypertensive patients with obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods:Data on clinical features and biochemical measurements were retrospectively analyzed in93 hypertensive patients.These patients were then divided into OSAHS group(n=42)and non-OSAHS group(n=51)according to polysomnograph(PSG)findings.Results:(1)Body weight,body mass index(MBI),neck,waist and hip circumferences,waist-hip ratio,and systolic blood pressure were higher in OSAHS group than in nonOSAHS group.Patients with OSAHS also had significantly higher levels of fasting plasma glucose(FPG),2-hour plasma glucose(2HPG),fasting insulin(FIns) and insulin resistance index(HOMAIR) total cholesterol(TC),triglyceride(TG),and low-density lipoprotein cholesterol(LDL-C)(all P <0.05).(2) Frequency and duration of apnea-hypopnea,apnea-hypopnea index(AHI),mean nocturnal oxygen saturation,total rate and duration of oxygen saturation <90%,and the percentage of oxygen saturation<90% during sleep were greatly increased in OSAHS group compared with non-OSHAS group(all P<0.01).(3) Insulin resistance correlated positively with TC,TG,FIns,FPG,2hPG,body weight,BMI,neck,waist and hip circumferences,waist-hip ratio,AHI,frequency and duration of apnea-hypopnea,and total reate and duration of oxygen saturation<90%,but were inversely related to mean nocturnal oxygen saturation.(4) Multiple linear stepwise regression analysis showed that FIns,FPG,waist circumference and AHI(duration of apnea-hypopnea) were independent factors for insulin resistance.Conclusion : Abnormal glucose metabolism and nocturnal hypoxia may be implicated in the development of insulin resistance for hypertensive patients with OSAHS.