阻塞性睡眠呼吸暂停与代谢综合征相关机制的探讨

目的　探讨老年人阻塞性睡眠呼吸暂停综合征 (OSAS)与代谢综合征 (MS)临床并存率较高的可能原因及机制。　 方法　将老年鼾症者 79例分为单纯性鼾症者 (对照组 )及OSAS组 ,并根据呼吸暂停低通气指数(AHI)和最低脉氧饱和度 (LSpO2 )分别将OSAS患者进一步分为轻中度及重度OSAS组。比较MS在各组的发生率。测量多导睡眠监测参数 :AHI、LSpO2 、平均脉氧饱和度 (ASpO2 ) ;外周循环中代谢参数 :空腹血糖 (FBG)、总胆固醇 (TC)、甘油三酯 (TG)、高密度脂蛋白胆固醇 (HDL C)、低密度脂蛋白胆固醇 (LDL C)、真胰岛素 (TI)与胰岛素原 (PI)、血压和体内稳态模式评估 (HOMA)指数 ,以及某些人体指数 :体质量指数 (BMI)、腰围 (WC)及颈围 (NC) ,并分析它们的相关性。　 结果　所有OSAS患者中 2 7 9%并存有MS。重度OSAS组的MS发生率明显高于对照组 (P <0 0 5 )。HOMA指数、PI水平均与LSpO2 、ASpO2 呈显著性负相关 ;LSpO2 、ASpO2 与BMI、WC、NC与舒张压呈显著性负相关 ,而与TC、HDL C呈显著性正相关。HOMA指数与PI是重度OSAS的危险因素 ,其OR值(95 %可信限 )分别为 1 92 6(1 3 0 3～ 2 846,P <0 0 1) ,1 716(1 716～ 2 5 0 5 ,P <0 0 1)。HOMA指数与重度OSAS的发生独立相关 ,其OR值为 1 991(1 3 0 8～ 3 0 3 0 ,

Investigation on associated pathogenesis between obstructive sleep apnea and metabolic syndromes in elderly snorers

Objective To investigate the associated pathogenesis of higher clinical coexistence of obstructive sleep apnea syndrome (OSAS) and metabolic syndrome (MS) in elderly snorers. Methods Through polysomnography examination,79 elderly habitual snorers were divided into simple snorers (control group) and OSAS group who were further divided into mild-to-moderate and severe OSAS groups based on their apnea hypopnea index (AHI) and the lowest pulse oxygen saturation (LSpO 2) during sleep respectively.The incidences of MS were compared among different groups.All cases were measured of polysomnography parameters such as AHI,LSpO 2 and average pulse oxygen saturation (ASpO 2),MS-associated parameters such as fasting blood glucose (FBG),total cholesterol (TC),triglyceride (TG),high-density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol (LDL-C),insulin and proinsulin (PI),homeostasis model assessment (HOMA) index and blood pressure (BP),as well as some body indexes:body mass index (BMI),waist circumference (WC) and neck circumference (NC).The correlations between them were analyzed. Results 27.9% of all the OSAS patients suffered from MS.The incidence of MS in severe OSAS group was significantly higher than that in control group (P<0.05). HOMA index and PI were negatively correlated with nocturnal LSpO 2 and ASpO 2 significantly.There were no statistically significant correlation of HOMA index and PI with AHI.LSpO 2 and ASpO 2 were negatively correlated with BMI,WC,NC and diastolic BP,but positively correlated with TC and HDL-C significantly. HOMA index and PI were risk factors of severe OSAS and the odds ratio (OR) was 1.926 (1.303-2.846,P<0.01) and 1.716 (1.716-2.505,P<0.01) respectively. HOMA index and severe OSAS were independently correlated and the OR was 1.991 (1.308-3.030,P<0.01) Conclusions There was a close correlation between OSAS and MS.IR might play an important role in the coexistence of OSAS and MS,and the OSAS patients with a lower SpO_2 present with IR more easily.