Clarenbach Christian F, West Sophie D, Kohler Malcolm
Pulmonary Division, University Hospital Zurich, Switzerland.
Discov Med. 2011 Jul;12(62):17-24.
Obstructive sleep apnea (OSA) and type 2 diabetes are both closely related to obesity and their prevalence is increasing due to the rising average body weight in Western countries. The findings of epidemiological studies have implicated that OSA increases the risk for cardiovascular disease, and metabolic disturbances, such as insulin resistance, may link OSA to vascular morbidity. A number of observational clinical studies have evaluated the relationship between OSA and insulin resistance, suggesting an independent association. However, the confounding effect of obesity complicates the establishment of a causal relationship between OSA and insulin resistance. Potential mechanisms that may underpin this relationship were evaluated in animal and human experimental studies and include intermittent hypoxia, arousals from sleep with concomitant sympathetic activation and sleep fragmentation. Currently only three randomized controlled trials investigating the effects of OSA on insulin resistance have been published. In these trials OSA patients were randomly assigned to treatment with continuous positive airway pressure (CPAP) or subtherapeutic CPAP and treatment effects on various measures of insulin resistance were examined. In two of these trials there was no effect of CPAP on glucose metabolism and in one trial a small beneficial effect of CPAP was observed. Further carefully conducted clinical studies and randomized controlled interventional CPAP trials are needed to determine the extent to which OSA is a risk factor for diabetes and its effect on glucose metabolism.
阻塞性睡眠呼吸暂停（OSA）与2型糖尿病均与肥胖密切相关，且由于西方国家平均体重的上升，它们的患病率也在增加。流行病学研究结果表明，OSA会增加心血管疾病风险，而代谢紊乱（如胰岛素抵抗）可能将OSA与血管疾病联系起来。多项观察性临床研究评估了OSA与胰岛素抵抗之间的关系，提示二者存在独立关联。然而，肥胖的混杂效应使OSA与胰岛素抵抗之间因果关系的确立变得复杂。动物和人体实验研究评估了可能支撑这种关系的潜在机制，包括间歇性缺氧、伴随交感神经激活的睡眠觉醒以及睡眠片段化。目前仅发表了三项调查OSA对胰岛素抵抗影响的随机对照试验。在这些试验中，OSA患者被随机分配接受持续气道正压通气（CPAP）治疗或亚治疗性CPAP治疗，并检测治疗对各种胰岛素抵抗指标的影响。在其中两项试验中，CPAP对糖代谢无影响，而在一项试验中观察到CPAP有轻微有益作用。需要进一步开展精心设计的临床研究和随机对照CPAP干预试验，以确定OSA作为糖尿病风险因素的程度及其对糖代谢的影响。
