阻塞性睡眠呼吸暂停患者的心血管风险与胰岛素抵抗

Cardiovascular risk and insulin resistance in patients with obstructive sleep apnea.

作者信息

Tkacova Ruzena, Dorkova Zuzana, Molcanyiova Angela, Radikova Zofia, Klimes Iwar, Tkac Ivan

机构信息

Department of Respiratory Medicine, Faculty of Medicine and L. Pasteur Teaching Hospital, Kosice, Slovakia.

出版信息

Med Sci Monit. 2008 Sep;14(9):CR438-44.

PMID:18758413

Abstract

BACKGROUND

Obstructive sleep apnea (OSA) has been linked to cardiovascular and cerebrovascular diseases in previous studies. However, it remains unclear whether OSA relates to cardiovascular outcomes independently of obesity and/or insulin resistance.

MATERIAL/METHODS: At a tertiary referral teaching hospital, this cross-sectional analysis of 98 subjects (28 without, 39 with mild-moderate, and 31 with severe OSA) aimed to determine whether OSA relates to National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) cardiovascular risk independently of obesity and insulin resistance. OSA was diagnosed by attended polysomnography. The insulin resistance index (HOMA-IR) was based on a homeostasis model assessment method.

RESULTS

Of the patients without to those with mild-moderate to those with severe OSA, significant increases were observed in NCEP ATP III risk [median (25%, 75% quartiles) from 2.0 (1.0, 8.0) to 3.0 (1.0, 12.0) to 16.0 (5.3, 20.0)%, p <0.001 for the trend] in association with increases in HOMA-IR (p<0.001), diastolic (p=0.039) and mean blood pressure (p=0.016), serum triglycerides (p=0.047), apolipoprotein B (p=0.039), plasma fibrinogen (p=0.013), and fasting glucose levels (p=0.002). Compared with subjects without sleep apnea, patients with severe OSA had significantly higher odds for NCEP ATP III risk higher than 10% (moderately high and high cardiovascular risk) (odds ratio: 4.06, 95% confidence interval: 1.02-16.25, p=0.048) after adjustment for body mass index and HOMA-IR.

CONCLUSIONS

These findings suggest that severe OSA is related to higher cardiovascular risk independently of obesity and insulin resistance.

摘要

背景

先前的研究已将阻塞性睡眠呼吸暂停（OSA）与心血管和脑血管疾病联系起来。然而，尚不清楚OSA是否独立于肥胖和/或胰岛素抵抗而与心血管结局相关。

材料/方法：在一家三级转诊教学医院，对98名受试者（28名无OSA、39名轻度至中度OSA和31名重度OSA）进行的这项横断面分析旨在确定OSA是否独立于肥胖和胰岛素抵抗而与美国国家胆固醇教育计划成人治疗小组第三次报告（NCEP ATP III）的心血管风险相关。通过值守多导睡眠图诊断OSA。胰岛素抵抗指数（HOMA-IR）基于稳态模型评估方法。

结果

从无OSA患者到轻度至中度OSA患者再到重度OSA患者，随着HOMA-IR升高（p<0.001）、舒张压（p=0.039）和平均血压（p=0.016）升高、血清甘油三酯（p=0.047）升高、载脂蛋白B（p=0.039）升高、血浆纤维蛋白原（p=0.013）升高以及空腹血糖水平升高（p=0.002），NCEP ATP III风险显著增加[中位数（第25%、第75%四分位数）从2.0（1.0，8.0）升至3.0（1.0，12.0）再升至16.0（5.3，20.0）%，趋势p<0.001]。与无睡眠呼吸暂停的受试者相比，在调整体重指数和HOMA-IR后，重度OSA患者NCEP ATP III风险高于10%（中度高和高心血管风险）的几率显著更高（优势比：4.06，95%置信区间：1.02 - 16.25，p=0.048）。