CAJ | 학술논문

目的评估以持续气道正压通气(CPAP)为主的规范治疗对老年人阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并2型糖尿病及胰岛素抵抗的疗效. 方法将63例确诊为OSAHS合并2型糖尿病的老年患者随机分为CPAP组32例和对照组31例,对照组给予饮食控制、合理运动、降糖药物等常规治疗,CPAP组给予CPAP联合常规治疗的规范治疗,观察治疗后7d、1个月、3个月患者的空腹血糖(FBG)、口服葡萄糖耐量试验(OGTT)、胰岛素抵抗的体内稳态模型评估(HOMA-IR)指数、体质指数(BMI)、呼吸暂停低通气指数(AHI)、最低血氧饱和度(L-SaO2)和胰岛素每日应用量变化,治疗前和治疗后3个月查糖化血红蛋白(HbA1c). 结果 CPAP组患者治疗后7 d FBG、OGTT 2 h、HOMA-IR、AHI、胰岛素每日应用量明显降低,L-SaO2显著升高;治疗后1个月BMI显著降低;治疗后3个月HbA1c明显降低.对照组L-SaO2随时间变化显著降低,治疗后3个月胰岛素每日应用量明显增加.治疗前两组各观察值差异均无统计学意义,除治疗后7d两组BMI差异无统计学意义外,两组治疗后各观察值差异均有统计学意义(均P＜0.05). 结论与单一的常规治疗方法比较,以CPAP为主的规范治疗对提高OSAHS合并2型糖尿病患者对胰岛素的敏感性、改善胰岛素抵抗更有效.
목적 평고이지속기도정압통기(CPAP)위주적규범치료대노년인조새성수면호흡잠정저통기종합정(OSAHS)합병2형당뇨병급이도소저항적료효. 방법 장63례학진위OSAHS합병2형당뇨병적노년환자수궤분위CPAP조32례화대조조31례,대조조급여음식공제、합리운동、강당약물등상규치료,CPAP조급여CPAP연합상규치료적규범치료,관찰치료후7d、1개월、3개월환자적공복혈당(FBG)、구복포도당내량시험(OGTT)、이도소저항적체내은태모형평고(HOMA-IR)지수、체질지수(BMI)、호흡잠정저통기지수(AHI)、최저혈양포화도(L-SaO2)화이도소매일응용량변화,치료전화치료후3개월사당화혈홍단백(HbA1c). 결과 CPAP조환자치료후7 d FBG、OGTT 2 h、HOMA-IR、AHI、이도소매일응용량명현강저,L-SaO2현저승고;치료후1개월BMI현저강저;치료후3개월HbA1c명현강저.대조조L-SaO2수시간변화현저강저,치료후3개월이도소매일응용량명현증가.치료전량조각관찰치차이균무통계학의의,제치료후7d량조BMI차이무통계학의의외,량조치료후각관찰치차이균유통계학의의(균P＜0.05). 결론 여단일적상규치료방법비교,이CPAP위주적규범치료대제고OSAHS합병2형당뇨병환자대이도소적민감성、개선이도소저항경유효.
Objective To evaluate the efficacy of continuous positive airway pressure (CPAP)-based standard treatment on obstructive sleep apnea-hypopnea syndrome (OSAHS) patients with type 2 diabetes and insulin resistance (IR) in the elderly.Methods 63 elderly type 2 diabetes patients diagnosed as OSAHS were randomly divided into control group (n =31) and CPAP group (n =32).Patients in control group were treated with conventional therapy including diet control,exercise and antidiabetic drugs,and patients in CPAP group were treated with CPAP treatment combined with conventional therapy.Fasting glucose (FBG),oral glucose tolerance test (OGTT),homeostasis model assessment of IR index (HOMA-IR),body mass index (BMI),apnea-hypopnea index (AHI),lowest oxygen saturation (L-SaO2) and the dosage of insulin application were observed after 7 days,1 month,3 months of the treatment.Glycosylated hemoglobin (HbA1c) was determined before and after 3 months of the treatment.Results In CPAP group,levels of FBG and 2 h OGTT glucose,HOMA-IR,AHI,daily insulin dosage were significantly reduced and L-SaO2 was significantly increased after 7 days of the treatment; BMI was significantly reduced after 1 month of the treatment;HbA1c level was significantly reduced after 3 months of the treatment.In control group,L-SaO2 was significantly reduced along with the multiple time points; daily insulin dosage was significantly increased after 3 months of the treatment.There were no significant differences in all observed indicators between groups before treatment.There were significant differences in the observed indicators between groups after treatment except for BMI after 7 days of the treatment.Conclusions Compared with conventional therapy,CPAP-based standard treatment has more efficacy on increasing insulin sensitivity and improving insulin resistance in elderly patients with OSAHS and type 2 diabetes.