[阻塞性睡眠呼吸暂停/低通气综合征与胰岛素抵抗之间的关系]

[Relationship between obstructive sleep apnea/hypopnea syndrome and insulin resistance].

作者信息

Zhang Li-qiang, Yao Wan-zhen, Wang Yu-zhu, Ren Bin, Lin Ya-ping

机构信息

Department of Respiratory Medicine, Peking University Third Hospital, Beijing 100083, China.

出版信息

Zhonghua Nei Ke Za Zhi. 2006 Mar;45(3):184-7.

PMID:16624145

Abstract

OBJECTIVE

To investigate whether obstructive sleep apnea/hypopnea syndrome (OSAHS) is independently associated with insulin resistance (IR).

METHODS

We recruited 60 male obese patients with OSAHS [OSAHS group, age (42.3 +/- 2.6) years, body mass index (BMI) (28.3 +/- 2.1) kg/m2, waist/hip ratio (WHR) 0.95 +/- 0.05], 60 male weight-matched obese patients without OSAHS [OB group, age (41.5 +/- 3.1) years, BMI (27.7 +/- 1.5) kg/m2, WHR 0.94 +/- 0.04] and 60 male normal weight subjects [NW group, age (41.8 +/- 2.4) years, BMI (22.6 +/- 1.9) kg/m2, WHR 0.86 +/- 0.05]. The subjects underwent polysomnography and OSAHS was defined as an apnea-hypopnea index (AHI) > or = 5. The systolic blood pressure and diastolic blood pressure were measured. IR was evaluated by fasting serum true insulin (TI) level and IR index based on the homeostasis model assessment method (HOMA-IR). In the OSAHS group, multiple linear regression was used with either TI or HOMA-IR as the dependent variable, and the corresponding set of independent variables included age, BMI, WHR, AHI and minimum oxygen saturation (MSpO2).

RESULTS

After adjustment for age, BMI, and WHR, the OSAHS group was more insulin resistant, as indicated by the higher levels of TI and HOMA-IR. Multiple linear regression showed that the central obesity parameter (WHR) was the major determinant of IR of the OSAHS group, while sleep-disordered breathing parameters (AHI and MSpO2) were also independent determinants of IR of the group (TI: AHI P = 0.017, TI: MSpO2 P = 0.005; HOMA-IR: AHI P = 0.008, HOMA-IR: MSpO2 P = 0.003).

CONCLUSION

OSAHS may be independently associated with IR.

摘要

目的

探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是否与胰岛素抵抗（IR）独立相关。

方法

我们招募了60例男性肥胖OSAHS患者[OSAHS组，年龄（42.3±2.6）岁，体重指数（BMI）（28.3±2.1）kg/m²，腰臀比（WHR）0.95±0.05]，60例体重匹配的无OSAHS的男性肥胖患者[肥胖组，年龄（41.5±3.1）岁，BMI（27.7±1.5）kg/m²，WHR 0.94±0.04]和60例体重正常的男性受试者[正常体重组，年龄（41.8±2.4）岁，BMI（22.6±1.9）kg/m²，WHR 0.86±0.05]。受试者接受多导睡眠图检查，OSAHS定义为呼吸暂停低通气指数（AHI）≥5。测量收缩压和舒张压。基于稳态模型评估法（HOMA-IR），通过空腹血清真胰岛素（TI）水平和IR指数评估IR。在OSAHS组中，以TI或HOMA-IR作为因变量进行多元线性回归，相应的自变量集包括年龄、BMI、WHR、AHI和最低血氧饱和度（MSpO₂）。

结果

在调整年龄、BMI和WHR后，OSAHS组的胰岛素抵抗更严重，表现为TI和HOMA-IR水平更高。多元线性回归显示，中心性肥胖参数（WHR）是OSAHS组IR的主要决定因素，而睡眠呼吸紊乱参数（AHI和MSpO₂）也是该组IR的独立决定因素（TI：AHI P = 0.017，TI：MSpO₂ P = 0.005；HOMA-IR：AHI P = 0.008，HOMA-IR：MSpO₂ P = 0.003）。