阻塞性睡眠呼吸暂停低通气综合征(OSAHS)和胰岛素抵抗的关系

目的研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的睡眠呼吸紊乱指标与其血清瘦素水平和胰岛素抵抗程度的关系。方法选择未接受任何治疗、经多导睡眠监测仪8 h睡眠监测确诊为OSAHS的男性患者54例,参照OSAHS诊治指南按睡眠暂停低通气指数(AHI)进行病情分度,其中轻-中度组(轻度9例,中度18例)和重度OSAHS组各27例,次日监测结束后空腹外周血瘦素、空腹胰岛素和血糖水平,计算体重指数(BMI)(体重/身高2)和HOMA-IR指数(空腹血糖×空腹胰岛素)/22.5]。结果重度OSAHS组的平均和最低SpO2皆显著低于轻-中度组,BMI、血清瘦素水平和HOMA指数则明显高于轻-中度组,上述指标在两组间比较皆有显著统计学差异(均P<0.01)。其中瘦素与BMI和AHI成正相关,与平均及最低脉氧饱和度均存在负相关。HOMA-IR指数则和BMI、AHI成正相关,和最低SpO2存在负相关。结论在OSAHS患者中,睡眠呼吸功能紊乱和肥胖、瘦素和胰岛素抵抗有关。

Insulin Resistance in 54 Cases with Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS)

Objective To investigate the relationship between sleep related hypoxemia,serum leptin level and the extent of insulin resistance in OSAHS patients.Methods Fifty-four male patients(diagnosed) as OSAHS with 8-hour PSG monitoring were enrolled in this study.According to their apnea-hypopnea index(AHI),these patients were divided into two groups: 27 cases in the mild/moderate group and 27 in the severe group.Body height and weight,serum leptin,fasting blood glucose(FBG) and fasting serum insulin(FINS) were measured and their body mass index(BMI) and HOMA-IR index were calculated afterwards.Results The nocturnal average SpO_2 and nocturnal lowest SpO_2 were significantly decreased in the severe OSAHS group than those in the mild-moderate group while the BMI,serum leptin level and HOMA index were increased in the former group with statistical significance(P<0.01). The serum leptin level and HOMA index were positively correlated with BMI and AHI and negatively correlated with the nocturnal lowest SpO_2 respectively with statistical significance.In addition,serum leptin concentration was also negatively correlated with nocturnal average SpO_2 level.Conclusion The extent of respiratory disturbance in OSAHS is closely related with obesity,leptin and other insulin resistance parameters.