阻塞性睡眠呼吸暂停低通气综合征与2型糖尿病的相关性研究

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与2型糖尿病并存率较高的可能原因及机制.方法 2008年5月至2009年12月在南京医科大学第一附属医院睡眠中心就诊,经多导睡眠监测104例患者被诊断患有鼾症,分为单纯性鼾症组(即对照组,n=19)及OSAHS组(n=85),根据呼吸暂停低通气指数和最低脉搏氧饱和度将OSAHS患者进一步分为轻度(n=50)及中-重度OSAHS亚组(n=35).比较各组2型糖尿病的发生率.分析多导睡眠监测参数呼吸暂停低通气指数、最低脉搏氧饱和度、平均脉搏氧饱和度,外周循环中代谢参数空腹血糖、真胰岛素与胰岛素原和稳态模型胰岛素抵抗指数(HOMA-IR),以及体重指数、腰围及颈围等的相关性.采用卡方检验、方差分析、Spearman相关分析和Logistic回归分析进行数据统计.结果 所有OSAHS患者中15.3%(13/85)并存有2型糖尿病.中-重度OSAHS组2型糖尿病发病率25.7%(9/35)]明显高于对照组5.3%(1/19),X2=4.942,P=0.026)]和轻度OSAHS组8.0%(4/50),X2=4.011,P=0.045)].Spearman相关分析显示HOMA-IR、胰岛素原水平与最低脉搏氧饱和度、平均脉搏氧饱和度呈显著负相关,与呼吸暂停低通气指数的相关性未达统计学意义.单因素Logistic回归分析提示HOMA-IR和胰岛素原是中-重度OSAHS的危险因素.多因素逐步Logistic回归分析提示HOMA-IR与中一重度OSAHS的发生独立相关.结论 OSAHS与2型糖尿病密切相关,夜间脉搏氧饱和度较低的OSAHS患者易于产生胰岛素抵抗,而胰岛素抵抗在OSAHS与2型糖尿病并存机制中发挥重要作用.

Association between obstructive sleep apnea hypopnea syndrome and type 2 diabetes mellitus

Objective To investigate the association of obstructive sleep apnea hypopnea syndrome (OSAHS)and type 2 diabetes mellitus.Methods This study was conducted from May 2008 to December 2009 from the subjects diagnosed at the Sleep Center of the First Affiliated Hospital of Nanjing Medical University.Based on polysomnography examination,104 habitual snorers were assigned to the simple snorer group(control group)and the OSAHS group which was further assigned to the mild OSAHS group and the moderate-to-severe OSAHS group according to the apnea hypopnea index(AHI)during sleep to compare the incidence of type 2 diabetes mellitus.Parameters among different groups were compared with Chi-square test and analysis of variance respectively.Spearman correlation analysis and Logistic regressive analysis were used to evaluate the correlation among AHI,minimM SaO2(mini-Spo2),mean SaO2,fasting blood glucose,true insulin,proinsulin,HOMA index,body mass index(BMI),waist circumference(WC) and neck circumference(NC).Results Type 2 diabetes mellitus was found in 15.3%(13/85)of all the OSAHSpatients.The incidence of type 2 diabetes mellitus in moderate-to-severe OSAHS group(25.7%(9/35))was significantly higher than that in the control group(5.3%(1/19),X2=4.942,P=0.026)and in the mild OSAHS group(8.0%(4/50),X2=4.011,P=0.045).Spearman correlation analysis indicated that HOMA index and P1 were negatively correlated with nocturnal mini-SpO2 and mean SpO2,There was no statistically significant correlation of HOMA index and P1 with AHI.Mini-SpO2 and mean SpO2 were negatively correlated with BMI,WC,and NC.Univariate logistic regression analysis suggested that the HOMA index and PI were risk factors of severe OSAHS(odds ratio was 1.924(1.302 to 2.847;P<0.01)or 1.714(1.175 to 2.507;P<0.01)).Conclusion There is an association between OSAHS and type 2 diabetes mellitus.Insulin resistance may play an important role in the coexistence of OSAHS and type 2 diabetes mellitus.The OSAHS patients with a lower SpO2 can be more susceptible to type 2 diabetes mellitus.