CPAP疗法对于合并OSA老年2型糖尿病患者血糖控制及睡眠质量影响

目的探讨持续气道正压通气(CPAP)疗法对合并阻塞性睡眠呼吸暂停(OSA)的老年2型糖尿病(T2DM)患者的血糖以及睡眠呼吸暂停的影响。方法选择2015年1月至2016年7月长江航运总医院武汉脑科医院收治的患有T2DM同时伴有新诊断的OSA的49例老年患者为研究对象。根据患者是否愿意接受CPAP治疗,分为CPAP组(n=20)和常规组(n=29)。CPAP组进行CPAP治疗,常规组使用口腔阻鼾器治疗。治疗前及治疗12周后,分别使用动态血糖监测系统(CGMS)以及多导睡眠监测对患者的血糖指标以及睡眠质量相关指标进行测定。结果经过12周的治疗,与治疗前及常规组治疗后比较,CPAP组患者的体质量、平均血糖波动幅度(MAGE)、平均日间血糖差异(MODD)、空腹血糖、氧减指数(ODI)、呼吸暂停低通气指数(AHI)、ESS指标均显著下降,平均血氧饱和度(SaO_2)显著上升(P<0.05),但糖化血红蛋白(Hb A1c)的下降无统计学意义(P>0.05)。结论合并OSA的T2DM老年患者接受CPAP治疗后,空腹血糖水平显著下降且血糖波动更小,睡眠呼吸暂停和低通气以及白天嗜睡状况均得到显著改善,睡眠质量得到极大提高。

CPAP therapy for elderly patients with type 2 diabetes combined OSA via influencing glycemic control and sleeping quality

Objective To investigate the effects of continuous positive airway pressure (CPAP) therapy for elderly type 2 diabetes (T2DM) patients combined with obstructive sleep apnea(OSA) by influencing glycemic control and sleeping quality.Methods A retrospective study was performed on 49 elderly T2DM patients combined OSA who were admitted from January 2015 to July 2016.Patients were divided into the CPAP group (n =20)and the control group(n =29).Patients in the CPAP group received CPAP therapy,and the others in the control group received the treatment using oral cavity anti-snoring device.To detect the blood glucose and sleeping quality using continuous glucose-monitoring system (CGMS) before and 12 weeks after treatment.Results Compared to the CPAP group before treatment and the control group after treatment,after 12 weeks of CPAP treatment in CPAP group,the body mass,mean amplitude of glycemic excursion (MAGE),mean of daily differences (MODD),fasting blood glucose (FBG),oxygen desaturation index (ODI),apnea hypopnea index(AHI) and ESS index all reduced,average oxyhemoglobin saturation(SaO2) significantly increased(P ＜0.05),the reduction of hemoglobin A1C (HbAlc) had no statistical significance (P ＞ 0.05).Conclusion After CPAP treatment,fasting blood glucose of elderly patients with type 2 diabetes combined with OSA significantly decreased and the fluctuation of average sleep glucose was smaller,sleep apnea and hypopnea was significantly less and daytime somnolence were significantly alleviated,therefore,the sleep quality are greatly improved.