2型糖尿病合并阻塞性睡眠呼吸暂停综合征

阻塞性睡眠呼吸暂停综合征（OSAS）是一种日渐受到重视的与多系统学科相关联的疾病。OSAS可引发呼吸、心血管及内分泌等多个系统疾病,危害人体健康,影响生活质量。近年来研究发现,2型糖尿病患者中存在OSAS的高患病率,OSAS患者又常合并2型糖尿病,且二者都极易诱发心血管疾病。本文就OSAS的概况、2型糖尿病合并OSAS的流行病学、发生机理及危害的干预治疗作一综述。     

2型糖尿病合并阻塞性睡眠呼吸暂停综合征2例治疗体会

临床中部分2型糖尿病患者常合并有睡眠呼吸障碍,尤其是阻塞性睡眠呼吸暂停综合征（OSAS）。本文报道2例2型糖尿病合并OSAS患者治疗体会。临床资料患者,男,65岁,因口干、多饮、多尿5年,睡眠时憋气6月入院。体检：BP138/78mmHg,神志清     

2型糖尿病与阻塞性睡眠呼吸暂停综合征

2型糖尿病人群中合并阻塞性睡眠呼吸暂停综合征较为常见,而阻塞性睡眠呼吸暂停综合征患者中2型糖尿病患病率也较普通人群明显升高.阻塞性睡眠呼吸暂停综合征导致的夜间间歇性缺氧以及片段睡眠可影响糖代谢及胰岛素敏感性,而2型糖尿病也可影响呼吸中枢及呼吸肌导致呼吸紊乱.对阻塞性睡眠呼吸暂停综合征进行合理治疗可改善血糖控制以及胰岛素抵抗.     

利拉鲁肽对睡眠呼吸暂停综合征合并2型糖尿病睡眠的影响

目的 探讨利拉鲁肽对睡眠呼吸暂停综合征合并2型糖尿病睡眠的影响.方法 选择2019年1月—2020年6月该院收治的阻塞性睡眠呼吸暂停综合征合并2型糖尿病患者80例,对照组使用二甲双胍片,观察组使用利拉鲁肽,比较两组睡眠过程中血氧饱和度变化情况,睡眠呼吸暂停监测主要指标变化情况,干预1疗程后睡眠呼吸暂停和夜间周期性腿动情...     

肥胖型2型糖尿病与阻塞性睡眠呼吸暂停低通气综合征

研究发现阻塞性睡眠呼吸暂停与肥胖、葡萄糖耐受不良以及2型糖尿病密切相关。肥胖易引起下颌及咽周脂肪沉积,上气道狭窄塌陷,并且胸腹壁脂肪增多,引起肺容量下降;另外,肥胖可使胰岛素敏感性下降,胰岛素受体数量减少,引起胰岛素抵抗,最终导致糖耐量减低和糖尿病的发生。     

阻塞性睡眠呼吸暂停综合征与2型糖尿病的关系

目的 探讨阻塞性睡眠呼吸暂停综合征（OSAS）与2型糖尿病（T2DM）的关系.方法 选择OSAS患者128例（观察组）,根据其睡眠呼吸紊乱程度分为轻、中、重度3组;另选80例呼吸道感染患者作为对照组,检测各组空腹血糖、餐后2h血糖、血浆胰岛素、餐后2h胰岛素.结果 观察组血糖与胰岛素水平均明显高于对照组（P均＜0.01）,其中17例确诊为T2DM;OSAS患者的睡眠呼吸紊乱程度越重,其血糖及胰岛素升高越明显（P＜0.01）.结论 OSAS可导致糖代谢异常,引发T2DM,其睡眠呼吸紊乱程度与糖代谢紊乱、高胰岛素血症水平明显相关,早期治疗OSAS对T2DM防治有重要临床价值.     

阻塞性睡眠呼吸暂停低通气综合征与2型糖尿病

阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者由于睡眠时频繁发生呼吸暂停和呼吸变浅,出现间歇低氧或伴高碳酸血症和睡眠结构紊乱,可导致多系统损害。OSAHS与2型糖尿病(type 2 diabetes mellitus,T2DM)在我国均属常见病和多发病。近年来,两者在临床、流行病学和发病机制等方面的相     

2型糖尿病伴阻塞性睡眠呼吸暂停综合征患者血糖波动与氧化应激的关系

目的探究2型糖尿病伴阻塞性睡眠呼吸暂停综合征患者血糖波动与氧化应激的关系。方法选择该院2012年2月至2014年2月收治的36例2型糖尿病伴阻塞性睡眠呼吸暂停综合征患者作为研究组,另外选择36例2型糖尿病不合并其他疾病患者作为对照组,利用动态血糖监测系统对患者进行72 h实时监测,测量日平均血糖波动(MAGE)、血糖水平标准差(SDBG)、餐后血糖波动幅度(MPPGE)、血脂水平、超氧化物歧化酶(SOD)、丙二醛(MDA)以及8-异前列腺素F2α(8-iso-PGF2α)。结果两组MAGE、SDBG、MPPGE、血脂水平、SOD、MDA以及8-iso-PGF2α水平差异有统计学意义(P<0.05),且SOD、MDA以及8-iso-PGF2α与MAGE之间存在相关性。结论 2型糖尿病伴阻塞性睡眠呼吸暂停综合征患者血糖波动与氧化应激之间存在相关性,会加重患者动脉粥样硬化的程度。     

阻塞性睡眠呼吸暂停综合征对老年2型糖尿病患者血糖水平的影响

目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)对老年2型糖尿病(T2DM)患者血糖水平的影响。方法选取2013年1月至2015年1月于该院就诊且确诊为T2DM的老年患者60例,根据呼吸暂停/低通气指数(AHI)分为单纯T2DM组(T2DM组)、T2DM组合并轻度OSAS组(轻缓合并组)、T2DM合并中度OSAS组(中度合并组)、T2DM合并重度OSAS组(重度合并组),分别比较四组患者的空腹血糖、餐后2 h血糖、空腹C肽、糖化血红蛋白水及同型半胱氨酸(HCY),并比较四组患者夜间血糖波动的平均幅度(MAGE)、白天MAGE及24 h MAGE。结果空腹血糖、餐后2 h血糖、空腹C肽、HCY、糖化血红蛋白、肌酐重度合并组中度合并组轻度合并组T2DM组(均P0.05);提示随着合并OSAS的程度加深,腹血糖、餐后2 h血糖、空腹C肽、HCY、糖化血红蛋白、肌酐值均增高。白天、夜间及24 h的血糖波动重度合并组中度合并组轻度合并组T2DM组(均P0.05);说明随着合并OSAS的程度加深,白天、夜间及24 h MAGE越大。结论 OSAS病情与老年T2DM患者的血糖水平呈正相关,控制OSAS的病情进展对控制T2DM患者血糖紊乱有重要意义。     

利拉鲁肽对2型糖尿病合并阻塞性睡眠呼吸暂停低通气综合征患者睡眠呼吸紊乱及微血管病变的影响

目的探讨胰高糖素样肽-1(GLP-1)类似物对2型糖尿病(T2DM)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者睡眠呼吸紊乱及微血管病变的影响。方法选取2017年1月至2018年12月河南省人民医院内分泌科及睡眠中心239例T2DM住院患者为研究对象,进行多导睡眠图(PSG)监测及糖尿病微血管病变筛查,纳入患糖尿病微血管病变的T2DM合并OSAHS患者93例,其中利拉鲁肽治疗患者50例作为治疗组,常规降糖治疗患者43例作为对照组,比较两组治疗6个月前后体质指数(BMI)、腰围、糖化血红蛋白(HbA1c)、血压、血脂、尿酸、呼吸暂停低通气指数(AHI)等指标的变化及糖尿病微血管病变改善情况。两组间比较采用t检验、非参数秩和检验或χ2检验,评价各指标与AHI变化值的相关性采用偏相关分析、协方差分析,利拉鲁肽与糖尿病微血管病变改善的相关性采用Logistic回归分析。结果治疗后利拉鲁肽治疗组较对照组BMI、腰围、HbA1c、收缩压、AHI下降更显著[分别为(-1.85±2.46)比(0.02±0.46)kg/m2、(-3.24±10.34)比(-0.07±0.88)cm、(-0.83±0.55)%比(-0.06±0.40)%、(-7.92±14.16)比(-0.56±16.16)mmHg(1 mmHg=0.133 kPa)、(-3.16±3.52)比(0.5±1.54)次/h,t=2.159~7.703,均P<0.05],糖尿病周围神经病变改善比例更高[26.0%(13/50)比9.3%(4/43),χ2=4.315,P<0.05]。治疗后AHI变化值与BMI变化值、腰围变化值、HbA1c变化值呈正相关(r=0.238、0.232、0.317,均P<0.05),与年龄呈负相关(r=-0.21,P<0.05)。调整年龄、糖尿病病程、BMI、腰围、收缩压、HbA1c等因素后,利拉鲁肽与AHI变化值水平有关(F=8.155,P=0.005)。调整年龄、糖尿病病程、BMI、腰围、HbA1c、收缩压、AHI等因素后,多因素Logistic回归分析显示利拉鲁肽对糖尿病周围神经病变有改善作用(OR=3.426,95%CI:1.024~11.46,P=0.046)。结论利拉鲁肽治疗可能有改善T2DM合并OSAHS患者睡眠呼吸紊乱及糖尿病周围神经病变的作用,对糖尿病肾脏病变、糖尿病视网膜病变无影响。     

艾塞那肽治疗肥胖2型糖尿病23例临床分析

在2型糖尿病患者中存在较为严重的胰岛素抵抗,患者血糖波动大,不易控制。艾塞那肽(exenatide)是胰高血糖素样肽-1(GLP-1)受体激动剂,是一种新型的2型糖尿病治疗药物。本研究就艾塞那肽在肥胖2型糖尿病患者中的作用与疗效进行探讨。     

Determinants of the Awakening Rise in Systemic Blood Pressure in Obstructive Sleep Apnea Syndrome

To investigate the factors responsible for the morning rise in blood pressure (BP) in obstructive sleep apnea syndrome (OSAS) we examined a group of 253 consecutive snorers or OSAS patients. On the basis of their AHI the patients were classified in four groups. BP was measured on the evening before sleep onset and on the following morning after 15min of rest by a finger arterial pressure device (Finapres). In 150 subjects BP was monitored during the night by a Finapres device. In the morning BP increased in the patient group with an average difference of 9.9 0.5 mmHg for systolic (SBP) and 9.9 0.4 mmHg for diastolic pressure (DBP). The increase was significant in snorers and OSAS patients without differences between groups. The morning rise in SBP was related to diurnal values of SBP, age and AHI whereas the time spent in apnea and the diurnal values of DBP significantly contributed to the DBP increase. In the subgroup of 150 patients in whom BP was analyzed during sleep, the awakening increase was related to the absolute BP value during sleep and to the BP changes from wakefulness to sleep. The magnitude of the BP changes from evening to morning was not dependent on the degree of BP variability during sleep. We conclude that the awakening increase in BP in patients with snoring or OSAS may be mediated by the setting of pressure response to apnea or to mechanical effort during sleep. Anthropometric variables and diurnal cardiovascular setting may play an additional role in modulating the final pressure response to upper airway obstruction.     

Relationship of body mass index with efficacy of exenatide twice daily added to insulin glargine in patients with type 2 diabetes

This post hoc analysis assessed the evidence behind common reimbursement practices by evaluating the relationship of body mass index (BMI) ranges (<30, 30–35 and >35 kg/m²) with treatment effects of exenatide twice daily among patients with type 2 diabetes. Patients received exenatide twice daily added to insulin glargine in two 30‐week studies (exenatide twice daily vs insulin lispro, n = 627; exenatide twice daily vs placebo, n = 259). No association of baseline BMI with changes in efficacy variables was observed. Glycated haemoglobin (HbA1c) reductions were significant (p < 0.0001) and similar across BMI range groups in the lispro‐comparator study and greater for exenatide versus placebo in the placebo‐controlled study. Significant weight loss occurred with exenatide across BMI range groups (p < 0.0001), while weight increased with both comparators. Achievement of HbA1c <7.0% (<53 mmol/mol) without weight gain was greater for exenatide versus comparators. Systolic blood pressure decreased across BMI range groups with exenatide in the lispro‐comparator study (p < 0.0001); changes in lipids were not clinically meaningful. Minor hypoglycaemia was less frequent for exenatide versus insulin lispro. These findings suggest that BMI alone should not limit clinical decision‐making or patient access to medication.     

Evaluation of exenatide vs. insulin glargine in type 2 diabetes: cost-effectiveness analysis in the German setting

Objectives: The objective of this analysis was to determine the cost-effectiveness of exenatide vs. insulin glargine in patients with type 2 diabetes failing to achieve glycaemic control with oral antidiabetic agents, in the German setting, from a third-party payer perspective.
Methods: Data from a published randomized controlled trial were used in combination with a published, validated computer simulation model of type 2 diabetes to project clinical and cost outcomes over a time horizon of 10 years. Cost data were obtained from published literature and expert opinion. Clinical and cost outcomes were discounted at 5% per annum. Sensitivity analyses were performed to establish key drivers and parameters.
Results: Treatment with exenatide compared with insulin glargine was projected to be associated with improvements in life expectancy of 0.016 years and quality-adjusted life expectancy of 0.280 quality-adjusted life years (QALYs), increased lifetime direct medical costs of € 3854 (€ 22 095 vs. € 18 242) and an incremental cost-effectiveness ratio (ICER) of € 13 746 per QALY. If quality of life was not taken into account, exenatide was associated with an ICER of € 238 201 per life year gained vs. insulin glargine. Sensitivity analyses revealed that outcomes were most sensitive to changes in assumptions for (dis)utility values relating to weight change and the rate of self-monitored blood glucose testing.
Conclusions: Exenatide was projected to be associated with similar clinical outcomes and increased costs compared with insulin glargine. Analysis of cost-effectiveness from a third-party perspective suggests that exenatide is likely to represent good value for money in the German setting.     

Obstructive Sleep Apnea Syndrome in Children

Snoring and obstructive sleep apnea are a frequent problem not only in adults, but also in children and adolescents, as can be seen from current epidemiological data. The epidemiology, etiology, diagnosis, and management of obstructive sleep apnea syndrome (OSAS) in adults have been adequately established on the basis of evidential data. As a result of this, both physicians and the public are increasingly aware of OSAS in adults. Although there are numerous parallels between pediatric and adult OSAS, the situation in children differs that in adults. There is a greater variety of symptoms in children with OSAS, diagnosis is often more difficult with serious consequences for growth and development of children. Treatment of OSAS in children is also different from that of the adult patient. There are many possible causes for the development of obstructive sleep apnea in children. These include hypertrophy of the tonsils and syndromes such as Down syndrome, Pickwickian syndrome, Prader-Willi syndrome or Marfan syndrome. OSAS can, however, also be the result of obesity, midfacial dysplasia, retro- or micrognathia, allergic rhinitis or muscular dystrophy. Epidemiological data presented in the literature concerning the incidence of OSAS in children is extremely varied. This wide range is probably due to the fact that snoring may be misdiagnosed as OSAS. The diagnosis of OSAS in children may only be made by considering clinical history (such as rate of growth, tendency to fall asleep during the day, sleep disturbances, susceptibility to infection, etc.), polysomnography (if possible during several nights) and accompanying instrumental diagnosis including cephalometry or laryngoscopy. One of the problems of polysomnography in childhood is that performance and interpretation of the results have not yet been standardized or evaluated for different age groups. Treatment depends on the cause of OSAS and require multidisciplinary management involving the pediatrician, pediatric or adolescent psychiatrist, ear, nose, and throat specialist, maxillofacial surgeons, and neurosurgeons. Adenotonsillectomy (ATE) is the therapy generally chosen if the child has adenoidal vegetations and/or tonsillar hypertrophy. Corrective surgery is possible for rare malformation syndromes. Nocturnal masks for continuous positive airway nasal pressure or procedures for mask respiration are effective in children, but are only used in exceptional cases, such as when ATE is contraindicated or when symptoms of OSAS remain after surgery. The success of pharmacological treatment of OSAS in children has not been evaluated in controlled clinical trials.     

Obstructive Sleep Apnea as a Risk Factor for Type 2 Diabetes

Purpose

Cross-sectional studies have documented the co-occurrence of obstructive sleep apnea (hereafter, sleep apnea) with glucose intolerance, insulin resistance, and type 2 diabetes mellitus (hereafter, diabetes). It has not been determined, however, whether sleep apnea is independently associated with the subsequent development of diabetes, accounting for established risk factors.

Methods

This observational cohort study examined 1233 consecutive patients in the Veteran Affairs Connecticut Healthcare System referred for evaluation of sleep-disordered breathing; 544 study participants were free of preexisting diabetes and completed a full, attended, diagnostic polysomnogram. The study population was divided into quartiles based on severity of sleep apnea as measured by the apnea-hypopnea index. The main outcome was incident diabetes defined as fasting glucose level >126 mg/dL and a corresponding physician diagnosis. Compliance with positive airway pressure therapy, and its impact on the main outcome, also was examined.

Results

In unadjusted analysis, increasing severity of sleep apnea was associated with an increased risk of diabetes (P for linear trend <.001). After adjusting for age, sex, race, baseline fasting blood glucose, body mass index, and weight change, an independent association was found between sleep apnea and incident diabetes (hazard ratio per quartile 1.43; confidence interval 1.10-1.86). Among patients with more severe sleep apnea (upper 2 quartiles of severity), 60% had evidence of regular positive airway pressure use, and this treatment was associated with an attenuation of the risk of diabetes (log-rank test P = .04).

Conclusion

Sleep apnea increases the risk of developing diabetes, independent of other risk factors. Among patients with more severe sleep apnea, regular positive airway pressure use may attenuate this risk.