持续气道正压通气对阻塞性睡眠呼吸暂停低通气综合征合并新诊断2型糖尿病患者动态血糖的影响
지속기도정압통기대조새성수면호흡잠정저통기종합정합병신진단2형당뇨병환자동태혈당적영향
Effect of CPAP therapy on dynamic glucose level in OSAHS patients with newly diagnosed T2DM
  • 万方数据
    中华医学杂志 중화의학잡지
    National Medical Journal of China
    2015年 44期 3579-3583 ,共5页

    赵丽君%惠培林%谢宇平%侯一平%魏晓泉%马薇%王金凤%周丽雅%张文娟

    조려군%혜배림%사우평%후일평%위효천%마미%왕금봉%주려아%장문연

    睡眠呼吸暂停,阻塞性%糖尿病,2型%动态血糖监测%连续气道正压通气 睡眠呼吸暫停,阻塞性%糖尿病,2型%動態血糖鑑測%連續氣道正壓通氣
    수면호흡잠정,조새성%당뇨병,2형%동태혈당감측%련속기도정압통기
    Sleep apnea,obstructive%Diabetes mellitus,type 2%Dynamic glucose monitoring%Continuous positive airway pressure
    目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并新诊断2型糖尿病(T2DM)患者动态血糖水平的特点和评估持续气道正压通气(CPAP)治疗对血糖水平变化的影响.方法 选择2014年4月至2015年4月在甘肃省睡眠医学中心住院的OSAHS合并新诊断T2DM患者35例,对照组为新诊断单纯T2DM患者30例.所有受试者经过多导睡眠呼吸监测(PSG)和连续动态血糖监测(CGMS)获取不同时段的血糖水平和读取夜间血糖升高＞0.1 mmol· L-1·min-1报警次数.对OSAHS合并新诊断T2DM患者进行CPAP治疗的同时继续行PSG监测和CGMS检测.本研究通过甘肃省人民医院伦理委员会批准.结果 两组间年龄、性别比例、体质指数(BMI)、吸烟史、饮酒史、糖化血红蛋白(HbA1c)和血脂谱之间差异均无统计学意义(均P＞0.05).与单纯T2DM患者比较,OSAHS合并新诊断T2DM组患者颈围、腰臀比(WHR)较大;收缩压和舒张压较高;空腹血糖(FPG)[(9.4±3.2)比(7.3±2.1) mmol/L,P=0.028]和空腹胰岛素(FINS)[(19.2±8.7)比(11.1±4.7) mU/L,P=0.044]升高;稳态模型胰岛素抵抗指数(HOMA-IR)较高;24 h、日间、夜间和睡眠期间的平均血糖水平均显著升高(均P ＜0.05).OSAHS合并新诊断T2DM患者组CGMS系统平均夜间血糖升高＞0.1 mmol·L-1·min-1报警次数显著增多(P =0.001),经过CPAP治疗后该组患者的睡眠呼吸暂停/低通气紊乱指数(AHI)显著降低[(5.9±3.6)比(56.7±11.4)次/h,P＜0.001],夜间最低血氧饱和度(LSpO2)明显提高[(92.3±3.7)%比(81.5±20.2)%,P＜0.001)];24 h、日间、夜间和睡眠期间的平均血糖水平均显著降低(均P＜0.05);CGMS系统平均夜间血糖升高＞0.1 mmol·L-1·min-1报警次数显著减少(P =0.019);HOMA-IR明显减轻(P =0.043).经过多重线性回归分析显示AHI与OSAHS合并T2DM组睡眠期间平均血糖水平呈正相关(β=0.736,P＜0.001),LSpO2与其呈负相关(β=-0.889,P＜0.001).结论 OSAHS合并新诊断T2DM患者血糖水平显著高于单纯新诊断T2DM患者;CPAP治疗可明显改善OSAHS合并新诊断T2DM患者的血糖水平;AHI和LSpO2可能是睡眠期间患者平均血糖水平的影响因素.
    목적 탐토조새성수면호흡잠정저통기종합정(OSAHS)합병신진단2형당뇨병(T2DM)환자동태혈당수평적특점화평고지속기도정압통기(CPAP)치료대혈당수평변화적영향.방법 선택2014년4월지2015년4월재감숙성수면의학중심주원적OSAHS합병신진단T2DM환자35례,대조조위신진단단순T2DM환자30례.소유수시자경과다도수면호흡감측(PSG)화련속동태혈당감측(CGMS)획취불동시단적혈당수평화독취야간혈당승고＞0.1 mmol· L-1·min-1보경차수.대OSAHS합병신진단T2DM환자진행CPAP치료적동시계속행PSG감측화CGMS검측.본연구통과감숙성인민의원윤리위원회비준.결과 량조간년령、성별비례、체질지수(BMI)、흡연사、음주사、당화혈홍단백(HbA1c)화혈지보지간차이균무통계학의의(균P＞0.05).여단순T2DM환자비교,OSAHS합병신진단T2DM조환자경위、요둔비(WHR)교대;수축압화서장압교고;공복혈당(FPG)[(9.4±3.2)비(7.3±2.1) mmol/L,P=0.028]화공복이도소(FINS)[(19.2±8.7)비(11.1±4.7) mU/L,P=0.044]승고;은태모형이도소저항지수(HOMA-IR)교고;24 h、일간、야간화수면기간적평균혈당수평균현저승고(균P ＜0.05).OSAHS합병신진단T2DM환자조CGMS계통평균야간혈당승고＞0.1 mmol·L-1·min-1보경차수현저증다(P =0.001),경과CPAP치료후해조환자적수면호흡잠정/저통기문란지수(AHI)현저강저[(5.9±3.6)비(56.7±11.4)차/h,P＜0.001],야간최저혈양포화도(LSpO2)명현제고[(92.3±3.7)%비(81.5±20.2)%,P＜0.001)];24 h、일간、야간화수면기간적평균혈당수평균현저강저(균P＜0.05);CGMS계통평균야간혈당승고＞0.1 mmol·L-1·min-1보경차수현저감소(P =0.019);HOMA-IR명현감경(P =0.043).경과다중선성회귀분석현시AHI여OSAHS합병T2DM조수면기간평균혈당수평정정상관(β=0.736,P＜0.001),LSpO2여기정부상관(β=-0.889,P＜0.001).결론 OSAHS합병신진단T2DM환자혈당수평현저고우단순신진단T2DM환자;CPAP치료가명현개선OSAHS합병신진단T2DM환자적혈당수평;AHI화LSpO2가능시수면기간환자평균혈당수평적영향인소.
    Objective To investigate the characteristic of dynamic glucose level in obstructive sleep apnea-hypopnea syndrome (OSAHS) patients with newly diagnosed type 2 diabetes mellitus (T2DM) and to evaluate the effect of continuous positive airway pressure (CPAP) treatment on the glucose level.Methods A total of 65 cases of patients with T2DM who were newly diagnosed by oral glucose tolerance test (OGTT) were enrolled from April 2014 to April 2015 in Gansu Provincial Hospital, and divided into simple T2DM group (n =30) and OSAHS with T2DM group (n =35) according to aponea-hypopnea index (AHI) which was monitored by polysomnography (PSG).Their general clinical data were collected, and glucose level of different periods was monitored by continuous glucose moitoring system (CGMS).Changes of glucose level were compared between two groups before and after CPAP treatment.Results Age, gender proportion, BMI, smoking and drinking history, glycosylated hemoglobin (HbA1c) and blood lipid profile had no significantly difference between two groups.Longer neck circumstance and higher waist-hip ration (WHR) ,higher systolic blood pressure and diastolic blood pressure, higher fasting plasma glucose (FPG) [(9.4 ±3.2) vs (7.3 ±2.1)mmol/L, P =0.028]and fasting insulin (FINS) [(19.2 ±8.7) vs (11.1 ±4.7) mU/L,P =0.044] level, more serious homeostasis model assessment insulin resistance (HOMA-IR) were found in OSAHS patients with T2DM when compared to patients in simple T2DM group.The average dynamic glucose level of 24 hours, daytime, nocturnal and sleep time in OSAHS with T2DM group were higher than that in the simple T2DM group (all P ＜ 0.05).The alarming times when the average dynamic glucose level of nocturnal time was more than 0.1 mmol · L-1 · min-1 in T2DM with OSAHS was more than that in control group (P =0.001).After treatment of CPAP, the level of AHI [(5.9 ± 3.6) vs (56.7 ± 11.4) times/h, P＜0.001], average dynamic glucose level of 24 hours, day, nocturnal and sleep time were obviously decreased (all P ＜ 0.05);lowest saturation oxygen (LSpO2) was significantly increased [(92.3 ± 3.7) % vs (81.5-± 20.2) %, P ＜ 0.001];the alarming times and HOMA-IR were obviously decreased (P =0.019,0.043).According to multiple linear regression analysis, the AHI(β =0.736, P ＜ 0.001) in OSAHS with T2DM group was positively related to the average dynamic glucose level during sleep time, but the LSpO2 (β =-0.889, P ＜ 0.001) was negatively correlated.Conclusions OSAHS patients with newly diagnosed T2DM have higher glucose level than that in simple T2DM patients, and CPAP therapy can obviously decrease the glucose level in newly diagnosed T2DM patients with OSAHS.AHI and LSpO2 may influence the average dynamic glucose level during sleep time.
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