老年睡眠呼吸暂停综合征与胰岛素抵抗相关性研究

目的探讨老年阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea／hyponea syndrome，OSAHS）胰岛素抵抗和脂联素水平的相关性。方法2008年9月至11月在华山医院老年科因打鼾就诊的老年人共82例，根据多导睡眠图（polysomnography，PSG）结果分为单纯鼾症组（23例）和OSAHS组（59例）。测定空腹血搪（FBG）、血清总胆固醇（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），空腹胰岛素（Fins）和脂联素（adiponectin，APN），计算胰岛素抵抗指数（homeostasis model assessment for estimating insulin resistance．HOMA—IR）值。比较单纯鼾症组和OSAHS组的一般资料，代谢参数以及合并症（高血压、冠心病、高脂血症、脑血管疾病和糖尿病）的患病率；分析睡眠呼吸紊乱指标和APN及HOMA—IR等代谢指标的相关性。结果1．OSAHS组的体质指数（BMI），腰罔和TG明显高于单纯鼾症组，HDL低于单纯鼾症组。高血压、高脂血症、糖尿病和脑血管疾病的患病率在OSAHS组升高。2．OSAHS组的FBG，Fins，HOMA—IR水平升高，APN降低。3．相关分析显示HOMA—IR与BMI，腰围，呼吸暂停低通气指数（AHI），氧减饱和指数（ODI），SaO2〈90％（％TST）呈正相关，与LSaO2呈负相关。4．相关分析显示APN与BMI，腰围，Fins，HOMA-IR呈负相关；与AHI，ODI，SaO2〈90％（％TST）呈负相关，与LSaO2呈正相关。结论本研究证实OSAHS患者肥胖、糖脂代谢紊乱和脑血管疾病的患病率高于对照组，胰岛素抵抗程度增高，APN水平降低。夜间间断性低氧和胰岛素抵抗及APN相关。

Correlations between obstructive sleep apnea syndrome and insulin resistance

Objective To investigate insulin resistance （IR） and plasma adiponectin level in elder patients with obstructive sleep apnea/hypopnea syndrome （OSAHS）, and to see whether sleep-disordered breathing and/or plasma adiponectin level were associated with IR independent of obesity or fat distribution in OSAHS patients. Methods 82 elderly patients who came to Huashan sleep clinic for snoring were divided into 2 groups by PSG results： OSAHS group （n=59） and snoring group （n =23）. Metabolic parameters of all these patients were measured, including fasting insulin and adiponectin. Differences in IR and adiponetin level between the two groups were compared and analyzed. Simple correlations and multiple stepwise regressions were taken to explore the independent correlations of IR and/or APN with other metabolic parameters. Results 1. BMI, waist circumference （WC） and TG of OSAHS group were significantly higher than those of snoring group, while HDL level was lower. The prevalence of hypertension, diabetes, hyperlipidemia and cerebrovascular disease was higher in OSAHS group than that in snoring group. 2. FBG, Fins and HOMA-IR levels were significantly higher in snoring group, and serum APN level decreased significantly in OSAHS group. 3. Simple correlation analysis showed that BMI, WC, AHI, ODI and SaO2 〈 90 % （%TST） had a positive correlation, and LSaO2 had a negative correlation with HOMA-IR. 4. Simple correlation analysis showed that BMI, WC, Fins and HOMA-IR had a negative correlation, and AHI, ODI and SaO2〈90% （%TST） had a positive correlation with APN level. Conclusions Our study suggested that IR and plasma adiponectin level were higher in elderly patients with OSAHS. OSAHS was correlated with IR.