CAJ | 학술논문

本研究旨在探讨2型糖尿病患者睡眠障碍与动态血压节律的关系。应用匹兹堡睡眠质量指数( PSQI)将418例2型糖尿病患者分为无睡眠障碍组和睡眠障碍组,均行口服葡萄糖耐量试验、胰岛素释放试验和C-肽释放试验,行24 h动态血压监测,比较2组空腹和糖负荷后胰岛β细胞功能、血压昼夜节律和血压变异性等变化,对 PSQI 总分行相关及回归性分析。结果显示：(1)睡眠障碍组 HbA1C为(8.2±2.1)%,空腹胰岛素为(13.42±4.55)mU/L,胰岛素曲线下面积为(8.51±0.54)mU·L-1·min,空腹C肽为(2.42±1.25)ng/ml,C肽曲线下面积为(6.59±0.39)μg·L-1·min,稳态模型评估的胰岛素抵抗指数(HOMA-IR)为(4.63±1.12),均高于无睡眠障碍组的(7.4±1.8)%、(11.86±4.52)mU/L、(8.38±0.51) mU·L-1·min、(1.79±0.73)ng/ml、(6.49±0.43)μg·L-1·min和(3.86±0.97)(均P<0.05)。睡眠障碍组胰岛素敏感指数(ISI)为(-4.26±0.78),低于无睡眠障碍组(-4.05±0.62)(P<0.05)。(2)睡眠障碍组24 h平均收缩压和舒张压、夜间收缩压和舒张压、白天和夜间的收缩压均较无睡眠障碍组高(均P<0.05)。与无睡眠障碍组相比,睡眠障碍组的收缩压和舒张压标准差增高,变异系数增加(均P<0.05)。(3) PSQI总分与C肽曲线下面积、HOMA-IR、24 h 平均收缩压、夜间收缩压呈正相关(β=0.242,0.293,0.352,0.413,均P<0.05),与ISI、夜间收缩压下降百分率呈负相关(β=-0.124,-0.226,均P<0.05)。睡眠障碍可能通过多种机制导致血压昼夜节律发生异常改变,改善睡眠障碍可能有助于改善胰岛素抵抗、恢复正常血压节律。
본연구지재탐토2형당뇨병환자수면장애여동태혈압절률적관계。응용필자보수면질량지수( PSQI)장418례2형당뇨병환자분위무수면장애조화수면장애조,균행구복포도당내량시험、이도소석방시험화C-태석방시험,행24 h동태혈압감측,비교2조공복화당부하후이도β세포공능、혈압주야절률화혈압변이성등변화,대 PSQI 총분행상관급회귀성분석。결과현시：(1)수면장애조 HbA1C위(8.2±2.1)%,공복이도소위(13.42±4.55)mU/L,이도소곡선하면적위(8.51±0.54)mU·L-1·min,공복C태위(2.42±1.25)ng/ml,C태곡선하면적위(6.59±0.39)μg·L-1·min,은태모형평고적이도소저항지수(HOMA-IR)위(4.63±1.12),균고우무수면장애조적(7.4±1.8)%、(11.86±4.52)mU/L、(8.38±0.51) mU·L-1·min、(1.79±0.73)ng/ml、(6.49±0.43)μg·L-1·min화(3.86±0.97)(균P<0.05)。수면장애조이도소민감지수(ISI)위(-4.26±0.78),저우무수면장애조(-4.05±0.62)(P<0.05)。(2)수면장애조24 h평균수축압화서장압、야간수축압화서장압、백천화야간적수축압균교무수면장애조고(균P<0.05)。여무수면장애조상비,수면장애조적수축압화서장압표준차증고,변이계수증가(균P<0.05)。(3) PSQI총분여C태곡선하면적、HOMA-IR、24 h 평균수축압、야간수축압정정상관(β=0.242,0.293,0.352,0.413,균P<0.05),여ISI、야간수축압하강백분솔정부상관(β=-0.124,-0.226,균P<0.05)。수면장애가능통과다충궤제도치혈압주야절률발생이상개변,개선수면장애가능유조우개선이도소저항、회복정상혈압절률。
[Summary] To investigate the association between sleep disorder and ambulatory blood pressure rhythm in patients with type 2 diabetes. 418 patients with type 2 diabetes were divided into two groups according to Pittsburgh sleep quality index ( PSQI):patients without sleep disorder and patients with sleep disorder. Oral glucose tolerance test, insulin releasing test, and C-peptide releasing test were performed to investigate the differences in the β-cell function, the circadian rhythm of blood pressure, and blood pressure variation between the two groups after fasting and glucose-load. The correlation and regression analysis were performed between PSQI and other indicators. (1)The level of HbA1C , fasting plasma insulin, area under curve of insulin, fasting plasma C-peptide, area under curve of C-peptide, and homeostasis model assessment for insulin resistance ( HOMA-IR) were significantly higher in patients withsleepdisordercomparedtothoseinpatientswithoutsleepdisorder[(8.2±2.1)% vs(7.4±1.8)%,(13.42± 4.55vs11.86±4.52)mU/L,(8.51±0.54vs8.38±0.51)mU·L-1·min,(2.42±1.25vs1.79±0.73)ng/ml, (6.59±0.39vs6.49±0.43)μg·L-1·min,4.63±1.12vs3.86±0.97,allP<0.05]. Insulinsensitivityindex (ISI) was lower in patients with sleep disorder than that in patients without sleep disorder(-4. 26 ± 0. 78 vs-4. 05 ± 0.62,P<0.05). (2)Thelevelof24hmeansystolicanddiastolicbloodpressure,nocturalsystolicanddiastolicblood pressure, and systolic blood pressure during daytime and nighttime were significantly higher in patients with type 2 diabetes who were suffering from sleep disorder. The blood pressure variation was more marked in patients with sleep disorder. (3)Multiple stepwise regression analysis showed that PSQI score was positively related to area under curve of C-peptide, HOMA-IR, 24 h mean systolic blood pressure, and noctural systolic blood pressure (β=0. 242, 0. 293, 0. 352, 0. 413, all P<0. 05), and negatively related to ISI and decreasing ratio of noctural systolic blood pressure (β=-0. 124 and -0. 226, both P<0. 05). Sleep disorder may cause abnormal circadian rhythm of blood pressure through various mechanisms. Improving sleep disorder may help to ameliorate insulin resistance and restore normal circadian rhythm of blood pressure.