nCPAP治疗对OSAHS患者血清瘦素水平的影响

目的评价经鼻持续气道正压通气（nCPAP）治疗对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者血清瘦素水平及胰岛素抵抗的影响,探讨OSAHS患者血清瘦素水平和胰岛素抵抗的关系.方法对16例中重度OSAHS患者进行nCPAP治疗,治疗前后进行睡眠监测（PSG）,记录睡眠呼吸监测的相关指标,检测空腹血糖（FBG）、空腹血清瘦素及空腹胰岛素水平,采用稳态模型评估法（HOMA）评价并计算胰岛素抵抗指数（HOMA-IR）,对比nCPAP治疗前后各指标的差异,并对治疗后空腹血清瘦素水平的变化及胰岛素抵抗的变化与睡眠各参数的变化进行相关分析.结果 nCPAP治疗前后空腹血清瘦素水平有差异（P〈0.01）,而HOMA-IR、FBG、胰岛素、BMI差异不明显（P〉0.05）,瘦素水平的变化与最低血氧饱和度的变化及AHI的变化呈正相关.结论 nCPAP治疗可降低OSAHS患者的血清瘦素水平,改善睡眠呼吸紊乱,但胰岛素抵抗及空腹血糖无明显变化,治疗后瘦素水平的变化与最低氧饱和度及AHI的改善有关,提示在OSAHS患者中改善睡眠呼吸紊乱的重要性.

The Effects of Nasal Continuous Positive Airway Pressure (nCPAP) Treatment on Fasting Serum Leptin Concentration in Patients with OSAHS

Objective To evaluate the effects of nasal continuous positive airway pressure（nCPAP）treatment on fasting serum leptin concentration and insulin resistance in patients with OSAHS. Methods Fasting serum leptin levels,FPG,FINS,HOMA-IR,BMI,AHI,ESS,the lowest oxygen saturation,the mean oxygen saturation（Spo2） and the sleep time of oxygen saturation below 90% were measured before and after on nCPAP in16 moderate- severe OSAHS patients. The correlations of the change of serum leptin levels,the change of insulin resistance and indicators of the change of OSAHS with treatment were analyzed.Results The serum leptin levels,AHI,the sleep time of oxygen saturation below 90%,ESS were significantly decreased after nCPAP treatment（P0.01）, the nocturnal lowest SpO2 and the nocturnal average SpO2 were significantly increased after nCPAP treatment（P0.01）,while HOMA-IR, FBG, FINS and BMI did not change after treatment. The change of serum leptin levels was positively correlated with the change of the nocturnal lowest SpO2 and the change of AHI in OSAHS patients with treatment. Conclusion nCPAP therapy can reduce the serum leptin levels, improve sleep-disordered breathing,but can not improve insulin resistance and fasting serum glucose, the change of serum leptin levels is correlated with the change of the nocturnal lowest SpO2 and the change of AHI in OSAHS patients with nCPAP treatment,indicating the importance of improving sleep-disorder in OSAHS patients.