短期持续正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征伴2型糖尿病患者胰岛素敏感性的影响

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)伴2型糖尿病患者行UPPP前,应用短期(7 d)持续正压通气(CPAP)治疗对其胰岛素敏感性的影响.方法:选择由PSG确诊的中、重度OSAHS伴2型糖尿病并需要行UPPP的患者30例,记录其AHI及夜间最低血氧饱和度(LSaO2),采用稳态模式评估(HOMA)指数评估胰岛素的敏感性,行7 d CPAP治疗后,复查PSG和计算HOMA指数,并与治疗前做比较.结果:经过7 dCPAP治疗后,AHI及LSaO2明显改善(P<0.05),胰岛素敏感性升高(P<0.05);AHI与空腹胰岛素水平呈正相关(r=0.636 5,P<0.05),与胰岛素敏感性呈负相关(r=-0.622 9,P<0.05);夜间LSaO2与空腹胰岛素水平呈负相关(r=0.8889,P<0.05),与胰岛素敏感性呈正相关(r=0.952 6,P<0.05).结论:短期CPAP治疗能改善OSAHS伴2型糖尿病患者夜间低血氧的情况,增加其胰岛素的敏感性,降低UPPP的危险性.

The effect of short-time continuous positive airway pressure treatment on insulin sensitivity in patients with obstructive sleep apnea-hypop-nea syndrome and type 2 diabetes

Objective:To investigate the effects of short-time continuous positive airway pressure treatment before the surgery on insulin sensitivity in patients with obstructive sleep apnea-hypopnea syndrome and type 2 diabetes who need the operation of uvulopalatophargngoplasty.Method:Thirty cases of patients with moderate and severe obstructive sleep apnea-hypopnea syndrome and type 2 diabetes who need the operation of UPPP were included in this study.The apnea hypopnea index(AHI)and LSaO2 and the insulin sensitivity index(ISI) was evaluated by homeostasis model assessment(HOMA),after 7 days of effective CPAP treatment.Subsequently,the data of the PSG and the ISI were rechecked and compared to the data previously achieved.Result:After 7 days of effective CPAP treatment,the level of AHI and LSaO2 changed(P<0.05).The level of ISI improved(P<0.05),while the level of AHI was correlated with fasting blood insulin level(r=0.6365,P<0.05) and was inverse correlated with insulin sensitivity(r=-0.6229,P<0.05).There was an negative correlation between LSaO2 and fasting blood insulin level(r=-0.8889,P<0.05),and there was a correlation between LSaO2 and insulin sensitivity(r=0.9526,P<0.05).Conclusion: The 7 days of effective CPAP treatment could improve the hypoxia of patients,and it could enhance the ISI and could reduce the operation risk of UPPP.