Peled Nir, Kassirer Micha, Shitrit David, Kogan Yivgeny, Shlomi Dekel, Berliner Abraham Shlomo, Kramer Mordechai Reuven
Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petah Tiqwa, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Respir Med. 2007 Aug;101(8):1696-701. doi: 10.1016/j.rmed.2007.02.025. Epub 2007 Apr 26.
Obstructive sleep apnea (OSA) shares many cardiovascular risk factors with metabolic syndrome, including obesity, hypertension, insulin resistance, and pro-inflammatory state. This study aimed to examine the possible association of OSA severity with insulin resistance, inflammation and the metabolic syndrome. Ninety eight patients suspected for OSA (54.9+/-13.1 years) were studied. Overnight polysomnography and blood sampling was taken for glucose, insulin, high-density lipoprotein(HDL)-cholesterol, triglycerides, high-sensitivity C-reactive protein (Hs-CRP), and serum amyloid A (S-AA). Insulin resistance was estimated by the homeostatic model assessment (HOMA). Each patient was assigned a metabolic score according to the number of discrete components of metabolic syndrome identified, and categorized by OSA severity. Nine patients had primary snoring, nine had mild, 27 moderate and 53 severe OSA. Metabolic score increased from 1.56+/-1.01 to 2.92+/-1.20 with OSA severity (p=0.004), and was correlated independently with apnea hypopnea index (AHI; r=0.432, p=0.001) and with body mass index (BMI; r=0.518 p=0.001). Hs-CRP increased from 3.44+/-4.25 to 5.87+/-4.76mg/dL with OSA severity (p=0.066) and correlated with AHI (r=0.348; p=0.002). Insulin resistance, correlated significantly with AHI (r=0.390 p=0.021). Inflammation, insulin resistance and metabolic syndrome increase with OSA severity. The number of cardinal features of metabolic syndrome increases with an increase in OSA severity, regardless of the BMI.
阻塞性睡眠呼吸暂停（OSA）与代谢综合征有许多共同的心血管危险因素，包括肥胖、高血压、胰岛素抵抗和促炎状态。本研究旨在探讨OSA严重程度与胰岛素抵抗、炎症及代谢综合征之间可能存在的关联。对98例疑似OSA患者（年龄54.9±13.1岁）进行了研究。进行了整夜多导睡眠图监测，并采集血液样本检测血糖、胰岛素、高密度脂蛋白（HDL）胆固醇、甘油三酯、高敏C反应蛋白（Hs-CRP）和血清淀粉样蛋白A（S-AA）。通过稳态模型评估（HOMA）估算胰岛素抵抗。根据所确定的代谢综合征离散成分数量为每位患者分配一个代谢评分，并按OSA严重程度进行分类。9例患者为原发性打鼾，9例为轻度OSA，27例为中度OSA，53例为重度OSA。随着OSA严重程度增加，代谢评分从1.56±1.01增至2.92±1.20（p = 0.004），且与呼吸暂停低通气指数（AHI；r = 0.432，p = 0.001）及体重指数（BMI；r = 0.518，p = 0.001）独立相关。随着OSA严重程度增加，Hs-CRP从3.44±4.25增至5.87±4.76mg/dL（p = 0.066），并与AHI相关（r = 0.348；p = 0.002）。胰岛素抵抗与AHI显著相关（r = 0.390，p = 0.021）。炎症、胰岛素抵抗和代谢综合征随OSA严重程度增加而增加。无论BMI如何，代谢综合征主要特征的数量随OSA严重程度增加而增加。
