Chasens Eileen R
School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA 15261, USA.
Diabetes Educ. 2007 May-Jun;33(3):475-82. doi: 10.1177/0145721707301492.
The purpose of this article is to review the literature on obstructive sleep apnea, resultant daytime sleepiness, and type 2 diabetes mellitus, as the state of evidence exists.
A search was conducted on Medline and CINAHL using the search terms sleep apnea syndromes, obstructive sleep apnea, disorders of excessive somnolence, type 2 diabetes mellitus, and insulin resistance. This review includes only published research studies in English, in adults aged 19 years or older. There were 109 citations when the terms were combined, 36 citations that were identified as research studies, no randomized clinical trials, and only 1 qualitative study.
Obstructive sleep apnea and type 2 diabetes share the risk factors of age and central abdominal obesity. Recent studies suggest that obstructive sleep apnea and type 2 diabetes not only frequently coexist but also have a bidirectional association wherein each condition exacerbates the other. The mechanism whereby obstructive sleep apnea affects glucose metabolism is likely repetitive hypoxia and sleep fragmentation, which cause a stress response with increased sympathetic nervous system activity, increased fatigue-causing cytokines, and altered leptin levels that result in weight gain. In addition, daytime sleepiness results in an impaired mood state that may impede diabetes management.
Type 2 diabetes is prevalent in persons with obstructive sleep apnea, although the direction of causality is unknown. More research, including randomized clinical trials, is needed to determine how obstructive sleep apnea and daytime sleepiness affect persons with type 2 diabetes.
鉴于现有证据状况，本文旨在综述关于阻塞性睡眠呼吸暂停、由此导致的日间嗜睡以及2型糖尿病的文献。
在Medline和CINAHL数据库中进行检索，检索词为睡眠呼吸暂停综合征、阻塞性睡眠呼吸暂停、过度嗜睡障碍、2型糖尿病和胰岛素抵抗。本综述仅纳入以英文发表的针对19岁及以上成年人的研究。合并检索词后有109条引文，其中36条被确定为研究性文献，无随机临床试验，仅有1项定性研究。
阻塞性睡眠呼吸暂停和2型糖尿病具有年龄和腹型肥胖等共同危险因素。近期研究表明，阻塞性睡眠呼吸暂停和2型糖尿病不仅经常共存，而且存在双向关联，即每种疾病都会加重另一种疾病。阻塞性睡眠呼吸暂停影响葡萄糖代谢的机制可能是反复缺氧和睡眠片段化，这会引发应激反应，导致交感神经系统活动增加、促疲劳细胞因子增多以及瘦素水平改变，进而导致体重增加。此外，日间嗜睡会导致情绪状态受损，这可能会妨碍糖尿病的管理。
阻塞性睡眠呼吸暂停患者中2型糖尿病很常见，尽管因果关系的方向尚不清楚。需要更多的研究，包括随机临床试验，以确定阻塞性睡眠呼吸暂停和日间嗜睡如何影响2型糖尿病患者。
