CAJ | 학술논문

目的评估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(OSAHS)合并2型糖尿病患者(OWD)血糖波动以及胰岛素抵抗的作用.方法 23例OWD患者,给予持续6d动态血糖监测(CGM),后给予持续气道正压通气(CPAP)治疗.配对比较治疗前后治疗时段(6h,0:00～6:00)和非治疗时段(14 h,6:00 ～ 22:00)动态血糖水平和平均血糖波动幅度(MAGE).CPAP治疗前和治疗2d后测定空腹血糖(FBG)、空腹胰岛素(FINS),以稳态模型分析法(HOMA)评估稳态模型的胰岛素抵抗指数(HOMA-IR).结果 CPAP治疗后,治疗时段的动态血糖水平和MAGE均明显低于治疗前[(7.07±2.02)mmol/L比(6.34±1.57) mmol/L,(0.41±0.24)比(0.29±0.18),均P＜0.05]；非治疗时段血糖水平和MAGE亦明显低于治疗前[(8.04±1.99)mmoL/L比(7.64±1.81)mmol/L,(1.02±0.50)比(0.78±0.45),均P＜0.05]；HOMA-IR较治疗前明显降低(4.02±2.07比3.08±1.58,P＜0.05).结论短期CPAP治疗能改善OWD患者治疗时段的血糖水平和MAGE,并且此作用能够延及非治疗时段血糖；并能改善患者的胰岛素抵抗.
목적 평고단기지속정압통기치료대조새성수면호흡잠정저통기종합정(OSAHS)합병2형당뇨병환자(OWD)혈당파동이급이도소저항적작용.방법 23례OWD환자,급여지속6d동태혈당감측(CGM),후급여지속기도정압통기(CPAP)치료.배대비교치료전후치료시단(6h,0:00～6:00)화비치료시단(14 h,6:00 ～ 22:00)동태혈당수평화평균혈당파동폭도(MAGE).CPAP치료전화치료2d후측정공복혈당(FBG)、공복이도소(FINS),이은태모형분석법(HOMA)평고은태모형적이도소저항지수(HOMA-IR).결과 CPAP치료후,치료시단적동태혈당수평화MAGE균명현저우치료전[(7.07±2.02)mmol/L비(6.34±1.57) mmol/L,(0.41±0.24)비(0.29±0.18),균P＜0.05]；비치료시단혈당수평화MAGE역명현저우치료전[(8.04±1.99)mmoL/L비(7.64±1.81)mmol/L,(1.02±0.50)비(0.78±0.45),균P＜0.05]；HOMA-IR교치료전명현강저(4.02±2.07비3.08±1.58,P＜0.05).결론 단기CPAP치료능개선OWD환자치료시단적혈당수평화MAGE,병차차작용능구연급비치료시단혈당；병능개선환자적이도소저항.
Objective To assess the effects of short-term continuous positive airway pressure (CPAP) upon un-treatment hour glucose control via a continuous glucose monitoring system (CGMS) in patients with obstructivc sleep apnea hypopnea syndrome and type 2 diabetes (OWD).Methods A total of 23 case of hospitalized OWD were recruited.CGMS was applied for 2 days before and 4 days during CPAP treatment.The treatment hour ( 6 h,0:00 - 6:00 ) and un-treatment hour ( 14 h,6:00 - 22:00 ) glucose level and glucose variability were analyzed.Insulin resistance was asscsscd with fasting plasma blood glucose (FPG), plasma insulin (FINS) and homeostatic model assessment of insulin resistance index (HOMA-IR).Results The short-term CPAP treatment corrected sleep-disordered breathing and induced significant decreases of treatment and un-treatment hour glucose level ( (7.07 ± 2.02 ) mmol/L vs (6.34 ±1.57) mmol/L,( 8.04 ± 1.99) mmol/L vs (7.64 ± 1.81 ) mmol/L,both P ＜ 0.05 ).Glucose variability of treatment and un-treatment hours significantly decreased after CPAP treatment (0.41 ± 0.24 vs 0.29 ±0.18,1.02 ± 0.50 vs 0.78 ± 0.45,all P ＜ 0.05 ).Short-term treatment also induced an increase of insulin sensitivity,as indicated by a significant decrease of HOMA-1R (4.02 ± 2.07 vs 3.08 ± 1.58,P ＜ 0.05).Conclusion Short-term CPAP treatment in OWD may improve not only insulin resistance but also blood glucose and glucose variability during treatment and un-treatment hours.