Punjabi Naresh M, Ahmed Murtuza M, Polotsky Vsevolod Y, Beamer Brock A, O'Donnell Christopher P
Division of Pulmonary and Critical Care Medicine, Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA.
Respir Physiol Neurobiol. 2003 Jul 16;136(2-3):167-78. doi: 10.1016/s1569-9048(03)00079-x.
Sleep-disordered breathing (SDB) is a common condition with prevalence estimates of 2-4% in the general population. Epidemiological data suggest that SDB is an independent risk factor for cardiovascular disease. Glucose intolerance and insulin resistance are also well-recognized risk factors for the development of cardiovascular disease. A number of recent clinic-based studies suggest that, independent of obesity, SDB may adversely affect glucose tolerance and insulin sensitivity. The purpose of this study was to systematically review the evidence for the link between SDB, glucose intolerance, and insulin resistance. A MEDLINE search for SDB and metabolic disorders was performed and 24 articles that met the inclusion criteria were identified. Population-based studies indicate that habitual snoring is independently associated with glucose intolerance and insulin resistance. Studies that have used objective measures of SDB (e.g. polysomnography) provide further support for an independent link between SDB, glucose intolerance, and insulin resistance. However, studies on the treatment of SDB with continuous positive airway pressure (CPAP) have yielded inconsistent results and overall do not reveal an improvement in the metabolic disturbance after treatment. Although population-based prospective data on the metabolic implications of SDB are still lacking, current data point to an independent association between SDB and impaired glucose homeostasis. Potential mediators of this association include altered adrenergic function, the direct effects of hypoxemia on glucose regulation, and release of proinflammatory cytokines that affect metabolism.
睡眠呼吸紊乱（SDB）是一种常见病症，据估计在普通人群中的患病率为2%-4%。流行病学数据表明，SDB是心血管疾病的独立危险因素。葡萄糖不耐受和胰岛素抵抗也是公认的心血管疾病发病危险因素。最近一些基于临床的研究表明，独立于肥胖因素之外，SDB可能会对葡萄糖耐量和胰岛素敏感性产生不利影响。本研究的目的是系统回顾SDB、葡萄糖不耐受和胰岛素抵抗之间关联的证据。我们在MEDLINE数据库中检索了SDB与代谢紊乱相关文献，共识别出24篇符合纳入标准的文章。基于人群的研究表明，习惯性打鼾与葡萄糖不耐受和胰岛素抵抗独立相关。使用SDB客观测量方法（如多导睡眠图）的研究进一步支持了SDB、葡萄糖不耐受和胰岛素抵抗之间的独立关联。然而，关于持续气道正压通气（CPAP）治疗SDB的研究结果并不一致，总体而言，并未显示治疗后代谢紊乱有所改善。尽管目前仍缺乏基于人群的关于SDB代谢影响的前瞻性数据，但现有数据表明SDB与葡萄糖稳态受损之间存在独立关联。这种关联的潜在介导因素包括肾上腺素能功能改变、低氧血症对葡萄糖调节的直接影响以及影响代谢的促炎细胞因子释放。
