阻塞性睡眠呼吸暂停低通气与代谢综合征相关性的探讨

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与代谢综合征(MS)临床并存率较高的可能原因及机理.方法通过多导睡眠监测将104例习惯性鼾症者分为单纯性鼾症者(对照组)及OSAHS患者,并根据呼吸暂停低通气指数(AHI)和最低脉氧饱和度(miniSpO2)分别将OSAHS患者进一步分为轻中度及重度OSAHS组.比较MS在各组的发生率.分析多导睡眠监测参数-AHI、miniSpO2、平均脉氧饱和度(meanSpO2);外周循环中代谢参数-空腹血糖(FBG)、总胆固醇(TCH)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL)、真胰岛素(TI)与胰岛素原(PI)、血压和HOMA指数,以及某些人体测量参数-体重指数(BMI)、腰围及颈围等的相关性.结果所有OSAHS的患者中20%并存有MS.重度OSAHS组的MS发病率明显高于单纯鼾症者的对照组(P＜0.05).Spearman相关分析显示HOMA指数、PI水平均与miniSpO2、meanSpO2呈显著性负相关,但与AHI的相关未达统计学意义;miniSpO2、meanSpO2与BMI、腰围、颈围与舒张压显著性负相关,而与TCH、HLD呈显著性正相关.单因素Logistic回归分析提示HOMA指数与PI是重度OSAHS的危险因素,其OR值(95%可信限)分别为1.926(1.303～2.846)(P＜0.01),1.716(1.176～2.505)(P＜0.01).结论对国人鼾症的调查证实OSAHS与MS密切相关,夜间SpO2较低的OSAHS患者易于产生胰岛素抵抗,而胰岛素抵抗在OSAHS与MS并存机制中可起到重要作用.

Investigation on associated pathogenesis between obstructive sleep apnea hypopnea and metabolic syndromes

To investigate the associated pathogenesis of higher clinical coexistence of obstructive sleep apnea hypopnea syndrome (OSAHS) and metabolic syndrome (MS). Through polysomnography examination, 104 habitual snorers were divided into simple snorers (control group) and OSAHS patients who were further divided into mild-to-moderate and severe OSAHS groups based on their apnea hypopnea index (AHI) and the minimal pulse oxygen saturation (miniSpO2) during sleep respectively. The incidences of MS were compared among different groups. Correlation was analyzed among polysomnography parameters-AHI, miniSpO2 and mean pulse oxygen saturation (meanSpO2), MS-associated parameters-fasting blood glucose (FBG), total cholesterol (TCH), triglyceride (TG), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), insulin and proinsulin (PI), HOMA index and blood pressure (Bp), as well as some anthropometrical parameters-body mass index (BMI), waist circumference (WC) and neck circumference (NC). Coexisting MS was found in patients that were 20% of all the OSAHS. The incidences of MS in severe OSAHS groups were significantly higher than in control group(P <0.05). Spearman correlation analysis indicated that HOMA index and PI were negatively correlated with nocturnal miniSpO2 and meanSpO2 significantly. There were no statistically significant correlations of HOMA index and PI with AHI. miniSpO2 and meanSpO2 were negatively correlated with BMI, WC, NC and diastolic Bp but positively correlated with TCH and HDL significantly. Univariate Logistic regression analysis suggested that the HOMA index and PI were risk factors of severe OSAHS and the odds ratio (OR) was 1.926(1.303~2.846)(P <0.01)and 1.716(1.176~2.505)(P <0.01) respectively. Conclusion] It is confirmed from Chinese snorers that there is a close association between OSAHS and MS. IR may play an important role in the coexistence of OSAHS and MS. The OSAHS patients with a lower SpO2 are more susceptible to IR.