Elmasry A, Lindberg E, Berne C, Janson C, Gislason T, Awad Tageldin M, Boman G
Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Akademiska Sjukhuset, Uppsala, Sweden.
J Intern Med. 2001 Feb;249(2):153-61. doi: 10.1046/j.1365-2796.2001.00787.x.
Diabetes mellitus and obstructive sleep apnoea (OSA) are two prevalent medical problems. Both are strongly associated with obesity and hypertension. The aim of this study was to investigate whether the association between OSA and diabetes is entirely dependent on obesity in hypertensive men.
A population-based study.
The municipality of Uppsala, Sweden. Subjects and methods. In 1994, 2668 men aged 40-79 years answered a questionnaire regarding snoring, sleep disturbances and somatic diseases. An age-stratified sample of 116 hypertensive men was selected for a whole-night sleep study. Twenty-five of them had diabetes, defined as reporting regular medical controls for diabetes or having a fasting blood glucose > or =6.1 mmol L(-1).
The prevalence of severe OSA, defined as apnoea-hypopnoea index (AHI) > or =20 h(-1) was significantly higher in diabetic patients than in normoglycaemic subjects (36 vs. 14.5%, P < 0.05). The sample was divided into four groups based on the presence or absence of severe OSA and the presence or absence of central obesity, defined as waist-to-hip ratio (WHR) > or =1.0. In a logistic regression model with the non-OSA, WHR <1.0 as the reference group, the adjusted odds ratio (95% confidence interval) for diabetes was 11.8 (2.0-69.8) in the OSA, WHR > or =1.0 group, whilst it was 3.6 (0.9-14.8) in the non-OSA, WHR > or =1.0 group and 5.7 (0.3-112) in the OSA, WHR <1.0 group. In a linear regression model, after adjustment for WHR, there was a significant relationship between variables of sleep-disordered breathing and fasting insulin, glucose and haemoglobin A1c.
We conclude that, in hypertensive men, although obesity is the main risk factor for diabetes, coexistent severe OSA may add to this risk. Sleep breathing disorders, independent of central obesity, may influence plasma insulin and glycaemia.
糖尿病和阻塞性睡眠呼吸暂停（OSA）是两个常见的医学问题。两者都与肥胖和高血压密切相关。本研究的目的是调查在高血压男性中，OSA与糖尿病之间的关联是否完全取决于肥胖。
一项基于人群的研究。
瑞典乌普萨拉市。研究对象与方法。1994年，2668名年龄在40 - 79岁的男性回答了一份关于打鼾、睡眠障碍和躯体疾病的问卷。从这些人中选取了116名年龄分层的高血压男性进行整夜睡眠研究。其中25人患有糖尿病，定义为报告有糖尿病定期医疗检查或空腹血糖>或 = 6.1 mmol/L（-1）。
定义为呼吸暂停低通气指数（AHI）>或 = 20次/小时（-1）的重度OSA在糖尿病患者中的患病率显著高于血糖正常的受试者（36%对14.5%，P < 0.05）。根据是否存在重度OSA以及是否存在中心性肥胖（定义为腰臀比（WHR）>或 = 1.0）将样本分为四组。在一个以非OSA、WHR < 1.0为参照组的逻辑回归模型中，OSA、WHR >或 = 1.0组中糖尿病的调整后比值比（95%置信区间）为11.8（2.0 - 69.8），而非OSA、WHR >或 = 1.0组为3.6（0.9 - 14.8），OSA、WHR < 1.0组为5.7（0.3 - 112）。在一个线性回归模型中，在调整WHR后，睡眠呼吸紊乱变量与空腹胰岛素、血糖和糖化血红蛋白A1c之间存在显著关系。
我们得出结论，在高血压男性中，尽管肥胖是糖尿病的主要危险因素，但并存的重度OSA可能会增加这一风险。独立于中心性肥胖的睡眠呼吸障碍可能会影响血浆胰岛素和血糖水平。
