Lindberg Eva, Berne Christian, Elmasry Ahmed, Hedner Jan, Janson Christer
Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Akademiska sjukhuset, Uppsala, and Sleep Laboratory, Department of Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
Sleep Med. 2006 Oct;7(7):553-60. doi: 10.1016/j.sleep.2005.12.010. Epub 2006 Jun 5.
BACKGROUND & PURPOSE: Continuous positive airway pressure (CPAP) treatment has positive effects, including improved insulin sensitivity in sleep-laboratory cohorts with obstructive sleep apnea syndrome. There is still a lack of data on benefits obtained and possibilities to treat less symptomatic individuals. The aim of this study was to evaluate the effect of CPAP treatment on metabolic profile and quality of life (QoL) in a population-based sample of men with sleep apnea. Another purpose was to investigate the compliance to CPAP in this population.
A population-based sample of 38 men with an AHI>or=10 were treated with CPAP regardless of symptom profile. The controls included men with AHI <10 matched for age and hypertension. The effects were evaluated after 3 weeks and 6 months. Insulin resistance was quantified using the homeostasis model assessment (HOMA). Daytime sleepiness, QoL and subjective symptom load was assessed using the Epworth Sleepiness Scale (ESS), the Medical Outcomes Study Short Form Health Survey (SF-36) and the Minor Symptoms Evaluation-Profile (MSE-P) questionnaires, respectively.
Complete three-week data were obtained from 28 treated men and 28 controls. Compared with controls, the CPAP group displayed a greater reduction of fasting serum insulin (P=0.02), decrease in insulin resistance (P=0.01) and an increase in IGF-1 (P=0.005). The CPAP group further showed an improvement in the SF-36 domains of mental health (P=0.03) and vitality (P=0.06) and a reduction in symptom load in the sleep dimension of the MSE-P. Only 11 (29%) of subjects starting CPAP were still on treatment after 6 months. Those who still used CPAP had a higher score on ESS at baseline (11.3 (4.4) vs. 5.9 (3.4), P<0.0001).
Benefits of short-term treatment included signs of reduced insulin resistance and improved QoL. However, in this population-based sample compliance with CPAP was very low. More severe sleepiness was a positive predictive factor for treatment compliance.
持续气道正压通气（CPAP）治疗具有积极作用，包括改善阻塞性睡眠呼吸暂停综合征睡眠实验室队列中的胰岛素敏感性。对于症状较轻个体接受CPAP治疗所获得的益处及治疗可能性，目前仍缺乏数据。本研究旨在评估CPAP治疗对以社区为基础的男性睡眠呼吸暂停患者代谢状况及生活质量（QoL）的影响。另一个目的是调查该人群对CPAP的依从性。
选取38名呼吸暂停低通气指数（AHI）≥10的男性作为以社区为基础的样本，无论症状情况均接受CPAP治疗。对照组为年龄和高血压情况相匹配的AHI<10的男性。在3周和6个月后评估治疗效果。使用稳态模型评估（HOMA）对胰岛素抵抗进行量化。分别使用爱泼沃斯嗜睡量表（ESS）、医学结局研究简明健康调查（SF-36）问卷和轻微症状评估量表（MSE-P）问卷评估日间嗜睡、生活质量和主观症状负荷。
从28名接受治疗的男性和28名对照者中获得了完整的3周数据。与对照组相比，CPAP组空腹血清胰岛素水平降低幅度更大（P = 0.02），胰岛素抵抗降低（P = 0.01），胰岛素样生长因子-1（IGF-1）升高（P = 0.005）。CPAP组在SF-36问卷的心理健康（P = 0.03）和活力（P = 0.06）领域进一步改善，且MSE-P问卷睡眠维度的症状负荷降低。开始使用CPAP治疗的受试者中，6个月后仅有11名（29%）仍在接受治疗。仍使用CPAP的患者在基线时ESS得分更高（11.3（4.4）对5.9（3.4），P<0.0001）。
短期治疗的益处包括胰岛素抵抗降低和生活质量改善的迹象。然而，在这个以社区为基础的样本中，CPAP的依从性非常低。更严重的嗜睡是治疗依从性的一个积极预测因素。
