肥胖症伴阻塞性睡眠呼吸暂停与胰岛素抵抗及高胰岛素血症的关系

目的 探讨肥胖症伴阻塞性睡眠呼吸暂停（OSA）与胰岛素抵抗（IR）及高胰岛素血症（HI）的关系。方法 选择诊断为肥胖症伴OSA综合征（OSAS）患者60例和正常对照组20名行多导睡眠图检查和胰岛素敏感指数（ISI）、空腹胰岛素（FINS）、空腹血糖（FPG）、空腹C肽（FCP）、HbA1c及血清总胆固醇（TC），甘油三酯（TG)，高密度脂蛋白胆固醇（HDL－C)测定。结果 （1）OSAS组的FPG、HbA1c、FINS、FCP、TC、TG水平均明显高于正常组，且OSAS病情越重，轻、中、重度组间差别也越显著，而重度OSAS组HDL－C则较正常组明显降低。（2）ISI与睡眠呼吸暂停低通气指数（AHI）、经皮血氧饱和度（SpO2)降低大于4％的总次数、SpO2低于90％的时间呈显著负相关，而与入睡前SpO2的基础值、睡眠中SpO2最低值、SpO2平均值呈显著正相关。FINS则与AHI、SpO2降低大于4％的总次数、SpO2低于90％的时间呈显著正相关，而与入睡前SpO2的基础值、睡眠中SpO2最低值、SpO2平均值呈显著负相关。多元逐步回归分析结果表明：AHI为ISI与FINS的第2位独立决定因子，其作用仅次于体重指数。结论 OSA可独立肥胖、年龄等混淆因素，与IR与HI间存在独立相关关系。AHI、呼吸暂停持续时间及SpO2降低的程度是导致OSA患者血糖增高，血脂异常（特别是高TG血症）发生的重要的因素。

The relationship among obesity-associated obstructive sleep apnea, insulin resistance and hyperinsulinemia

Objective To study the relationship among obesity associated obstructive sleep apnea (OSA), insulin resistance and hyperinsulinemia. Methods Polysomnography was examined during sleep, and insulin sensitivity index (ISI), fasting plasma insulin (FINS), fasting plasma glucose (FPG), fasting C peptide (FCP), HbA 1c , total cholesterol (TC), triglyceride (TG) and high density lipoprotein cholesterol (HDL C) were determined in 60 obesity associated OSA syndrome patients and 20 normal control volunteers. Results FPG, HbA 1c , FINS, FCP, TC, TG were significantly higher in the OSA syndrome group than those in the control group. There were also significantly differences in these variables among the mild, moderate and severe group of OSA syndrome. HDL C was significantly lower in the severe group of OSA syndrome than that in the control group. ISI was significantly negatively correlated to apnea hypopnea index (AHI), the frequency of more than 4% decrease of transcutaneous saturation of oxygen (SpO 2), and the duration of less than 90% of SpO 2. However ISI was significantly positively correlated to the basic value of SpO 2 before sleep, the minimum value of SpO 2 and the mean value of SpO 2 during sleep. The correlation between FINS and above profiles was opposite to that of ISI. Multiple stepwise regression analysis showed that body mass index was the first risk factor and AHI was the second risk factor contributing to the development of insulin resistance and hyperinsulinemia. Conclusion OSA is an important risk factor for the development of insulin resistance and hyperinsulinemia independent of obesity and age. AHI, apnea duration and extent of SpO 2 decrease are the important factors contributing to the hyperlipidemia and abnormal glucose metabolism in OSA patients.