持续正压通气治疗对不同程度阻塞性睡眠呼吸暂停伴2型糖尿病患者糖代谢的影响
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摘要
目的探讨持续正压通气治疗(CPAP)对不同程度的阻塞性睡眠呼吸暂停(OSA)伴2型糖尿病(T2DM)患者体内糖代谢水平的影响。方法对32例治疗组OSA伴T2DM患者及15例对照组单纯T2DM患者行多导睡眠监测及糖代谢指标观察。采用不同治疗方法进行治疗,并比较治疗后的各项指标。结果 (1)缺氧程度与OSA伴T2DM患者体内糖代谢异常密切相关,并伴随炎性因子浓度的增加;(2)经3个月的CPAP及降糖综合治疗,轻度组OSA伴T2DM患者体内糖代谢指标及炎性因子浓度改善有统计学意义,而中重度组患者则无明显变化。经6个月的CPAP及降糖综合治疗,则可使中重度OSA伴T2DM患者体内糖代谢指标及炎性因子浓度得到明显改变。结论长期规律的CPAP治疗可显著改善T2DM伴OSA患者糖代谢异常,尤其是中重度OSA患者治疗效果更佳。
Objective To examine the relation between the effectiveness of continuous positive airway pressure(CPAP)and impaired glucose metabolism in the patients with different severities of obstructive sleep apnea(OSA)and type 2 diabetes mellitus(T2 DM). Methods polysomnography and glucose metabolism were observed in 32 patients with OSA with T2 DM in the treatment group and 15 patients with T2 DM in the control group. Different treatment methods were used for treatment,and the indexes after treatment were compared.Results The degree of hypoxia was closely related to the abnormal glucose metabolism in OSA patients with T2 DM,accompanied with the increase of inflammatory factor concentration. After 3 months of CPAP and hypoglycemic treatment,the improvement of glucose metabolism index and inflammatory factor concentration in mild OSA with T2 DM group was statistically significant,but there was no significant change in moderate and severe group. After 6 months of CPAP and hypoglycemic therapy,the glucose metabolism index and inflammatory factor concentration in patients with moderate and severe OSA with T2 DM were significantly changed. Conclusion Long-term regular CPAP treatment can significantly improve abnormal glucose metabolism in T2 DM patients with OSA,especially in patients with moderate to severe OSA.
Objective To examine the relation between the effectiveness of continuous positive airway pressure(CPAP)and impaired glucose metabolism in the patients with different severities of obstructive sleep apnea(OSA)and type 2 diabetes mellitus(T2 DM). Methods polysomnography and glucose metabolism were observed in 32 patients with OSA with T2 DM in the treatment group and 15 patients with T2 DM in the control group. Different treatment methods were used for treatment,and the indexes after treatment were compared.Results The degree of hypoxia was closely related to the abnormal glucose metabolism in OSA patients with T2 DM,accompanied with the increase of inflammatory factor concentration. After 3 months of CPAP and hypoglycemic treatment,the improvement of glucose metabolism index and inflammatory factor concentration in mild OSA with T2 DM group was statistically significant,but there was no significant change in moderate and severe group. After 6 months of CPAP and hypoglycemic therapy,the glucose metabolism index and inflammatory factor concentration in patients with moderate and severe OSA with T2 DM were significantly changed. Conclusion Long-term regular CPAP treatment can significantly improve abnormal glucose metabolism in T2 DM patients with OSA,especially in patients with moderate to severe OSA.
引文
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[6] AURORA R N,PUNJABI N M. Obstructive sleep apnoea and type 2 diabetes mellitus:a bidirectional association[J]. Lancet Respir Med,2013,1(4):329-338.
[7] ANOTHAISINTAWEE T,REUTRAKUL S,VAN CAUTER E,et al. Sleep disturbances compared to traditional risk factors for diabetes development:Systematic review and Meta-analysis[J].Sleep Med Rev,2016:30(12):11-24.
[8] HECHT L,M?HLER R,MEYER G. Effects of CPAP-respiration on markers of glucose metabolism in patients with obstructive sleep apnoea syndrome:a systematic review and meta-analysis[J]. Ger Med Sci,2011,9:1-13.
[9] IFTIKHAR I H,KHAN M F,DAS A,MAGALANG U J. Metaanalysis:continuous positive airway pressure improves insulin resistance in patients with sleep apnea without diabetes[J].Ann Am Thorac Soc,2013,10(2):115-120.
[10] KENT B D,CROTE L,RYAN S,et al. Diabetes mellitus prevalence and control in sleep-disordered breathing:the European Sleep Apnea Cohort(ESADA)study[J]. Chest,2014,146(4):982-990.
[11] DE SANTIS S,CAMBI J,TATTI P,et al. Changes in ghrelin,leptin and pro-inflammatory cytokines after therapy in Obstructive Sleep Apnea Syndrome(OSAS)patients[J]. Otolaryngol Pol,2015,69(2):1-8.
[12] CUCCIA A M,CAMPISI G,CANNAVALE R,et al. Obesity and craniofacial variables in subjects with obstructive sleep apnea syndrome:comparisons of cephalometric values[J]. Head Face Med,2007;3(1):1-9.
[2] MYHILL P C,DAVIS W A,PETERS K E,et al. Effect of continuous positive airway pressure therapy on cardiovascular risk factors in patients with type 2 diabetes and obstructive sleep apnea[J]. J Clin Endocrinol Metab,2012,97(11):4212-4218.
[3] ZHU B Q,CHAO M A,JINDARAT CHAIARD,et al. Effect of continuous positive airway pressure on glucose metabolism in adults with type 2 diabetes:A systematic review and Meta-analysis of randomized controlled trials[J]. Sleep Breath,2018,22(2):287-295.
[4]中华医学会糖尿病学分会. 2型糖尿病防治指南[J].中华医学杂志,2008,88(18):1227-1245.
[5]中华医学会呼吸疾病学分会睡眠呼吸障碍学组.阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版)[J].中华结核和呼吸杂志,2012,35:9-12.
[6] AURORA R N,PUNJABI N M. Obstructive sleep apnoea and type 2 diabetes mellitus:a bidirectional association[J]. Lancet Respir Med,2013,1(4):329-338.
[7] ANOTHAISINTAWEE T,REUTRAKUL S,VAN CAUTER E,et al. Sleep disturbances compared to traditional risk factors for diabetes development:Systematic review and Meta-analysis[J].Sleep Med Rev,2016:30(12):11-24.
[8] HECHT L,M?HLER R,MEYER G. Effects of CPAP-respiration on markers of glucose metabolism in patients with obstructive sleep apnoea syndrome:a systematic review and meta-analysis[J]. Ger Med Sci,2011,9:1-13.
[9] IFTIKHAR I H,KHAN M F,DAS A,MAGALANG U J. Metaanalysis:continuous positive airway pressure improves insulin resistance in patients with sleep apnea without diabetes[J].Ann Am Thorac Soc,2013,10(2):115-120.
[10] KENT B D,CROTE L,RYAN S,et al. Diabetes mellitus prevalence and control in sleep-disordered breathing:the European Sleep Apnea Cohort(ESADA)study[J]. Chest,2014,146(4):982-990.
[11] DE SANTIS S,CAMBI J,TATTI P,et al. Changes in ghrelin,leptin and pro-inflammatory cytokines after therapy in Obstructive Sleep Apnea Syndrome(OSAS)patients[J]. Otolaryngol Pol,2015,69(2):1-8.
[12] CUCCIA A M,CAMPISI G,CANNAVALE R,et al. Obesity and craniofacial variables in subjects with obstructive sleep apnea syndrome:comparisons of cephalometric values[J]. Head Face Med,2007;3(1):1-9.