Adv Cardiol. 2011;46:67-138. doi: 10.1159/000325106. Epub 2011 Oct 13.
The relationship between metabolic disorders and obstructive sleep apnea (OSA) is multidirectional. Obesity is recognized as the strongest risk factor for OSA. It is unknown whether metabolic syndrome and insulin resistance/type 2 diabetes mellitus contribute to the development or aggravation of OSA, although this is likely. Conversely, OSA may be a risk factor for metabolic disorders. Strong evidence suggests that OSA may increase the risk of developing insulin resistance, glucose intolerance and type 2 diabetes mellitus. OSA has also been associated with the development and/or aggravation of obesity, dyslipidemia, metabolic syndrome and nonalcoholic fatty liver disease - a liver manifestation of metabolic syndrome. In addition, metabolic disorders are confounding factors in OSA. Metabolic disorders and OSA share common intermediate pathogenic pathways, including alterations in autonomic nervous system regulation, increased inflammatory activity, and alterations in adipokine levels and endothelial dysfunction, which may be involved in the interplay between these conditions. Overall, this complexity makes it especially difficult to reveal and understand the links between OSA and metabolic and cardiovascular disorders. The International Diabetes Federation has recently published clinical practice recommendations suggesting that OSA patients should be routinely screened for markers of metabolic disturbance and cardiovascular risk, such as waist circumference, blood pressure, and fasting lipid and glucose levels. It also recommends that the possibility of OSA should be considered in the assessment of all patients with type 2 diabetes mellitus and metabolic syndrome.
代谢紊乱与阻塞性睡眠呼吸暂停（OSA）之间的关系是多向的。肥胖被认为是OSA最强的危险因素。虽然代谢综合征和胰岛素抵抗/2型糖尿病很可能会导致OSA的发生或加重，但目前尚不清楚它们是否起了作用。相反，OSA可能是代谢紊乱的一个危险因素。有力证据表明，OSA可能会增加发生胰岛素抵抗、葡萄糖耐量异常和2型糖尿病的风险。OSA还与肥胖、血脂异常、代谢综合征及非酒精性脂肪性肝病（代谢综合征的一种肝脏表现）的发生和/或加重有关。此外，代谢紊乱是OSA的混杂因素。代谢紊乱和OSA有共同的中间致病途径，包括自主神经系统调节改变、炎症活性增加、脂肪因子水平改变及内皮功能障碍，这些可能参与了这些病症之间的相互作用。总体而言，这种复杂性使得揭示和理解OSA与代谢及心血管疾病之间的联系变得尤为困难。国际糖尿病联盟最近发布了临床实践建议，指出应常规筛查OSA患者的代谢紊乱和心血管风险标志物，如腰围、血压、空腹血脂和血糖水平。该联盟还建议，在评估所有2型糖尿病和代谢综合征患者时应考虑OSA的可能性。
