肥胖、非糖尿病成人阻塞性睡眠呼吸暂停的风险随胰岛素抵抗状态而异。
Risk for obstructive sleep apnea in obese, nondiabetic adults varies with insulin resistance status.
机构信息
Department of Medicine, Stanford University Medical Center, Stanford, CA, USA.
出版信息
Sleep Breath. 2013 Mar;17(1):333-8. doi: 10.1007/s11325-012-0696-0. Epub 2012 Apr 7.
PURPOSE
Obstructive sleep apnea (OSA) is an increasingly common sleep disorder, especially among obese adults. Early identification of adults at risk for OSA would be of substantial benefit; however, the magnitude of the obesity epidemic requires that screening be performed judiciously. The study's aim was to utilize questionnaires that assess OSA risk and symptoms to test the hypothesis that the most insulin-resistant subset of obese individuals is at highest risk for OSA.
METHODS
Nondiabetic, overweight to obese volunteers underwent direct quantification of insulin sensitivity by measuring steady-state plasma glucose concentrations during the insulin suppression test. Insulin-sensitive and insulin-resistant individuals were administered the Berlin and STOP questionnaires to determine OSA risk status, and Epworth Sleepiness Scale (ESS) to evaluate daytime sleepiness. Fasting insulin and lipid/lipoprotein measurements were performed.
RESULTS
Insulin-mediated glucose disposal differed threefold (p < 0.001) between equally obese, insulin-resistant (n = 22) and insulin-sensitive (n = 14) individuals, associated with higher fasting insulin and triglyceride and lower high-density lipoprotein cholesterol (HDL-C) concentrations in insulin-resistant individuals. Fourteen (64 %) insulin-resistant as compared with 2 (14 %) insulin-sensitive individuals were found to be at high risk for OSA by both questionnaires (p < 0.01). Whereas half of insulin-resistant individuals met the ESS criteria for excessive daytime sleepiness, only one insulin-sensitive individual did (p = 0.011).
CONCLUSIONS
High risk for OSA and excessive daytime sleepiness is prevalent among the insulin-resistant subgroup of obese individuals. Surrogate estimates of insulin resistance based on fasting insulin, triglycerides, and/or HDL-C can be used to help identify those obese adults who would benefit most from OSA screening and referral for polysomnography.
目的
阻塞性睡眠呼吸暂停（OSA）是一种越来越常见的睡眠障碍，尤其是在肥胖成年人中。早期识别有 OSA 风险的成年人将带来巨大的益处；然而，肥胖症的流行程度要求进行明智的筛查。本研究的目的是利用评估 OSA 风险和症状的问卷，检验这样一个假设，即肥胖个体中胰岛素抵抗程度最高的亚组患 OSA 的风险最高。
方法
非糖尿病、超重至肥胖的志愿者通过测量胰岛素抑制试验期间稳态血浆葡萄糖浓度来直接量化胰岛素敏感性。给胰岛素敏感和胰岛素抵抗个体施用柏林和 STOP 问卷以确定 OSA 风险状况，并使用 Epworth 睡眠量表（ESS）评估白天嗜睡。进行空腹胰岛素和脂质/脂蛋白测量。
结果
胰岛素介导的葡萄糖处置在胰岛素抵抗（n=22）和胰岛素敏感（n=14）个体之间差异三倍（p<0.001），与胰岛素抵抗个体中较高的空腹胰岛素和甘油三酯以及较低的高密度脂蛋白胆固醇（HDL-C）浓度相关。与 2 名（14%）胰岛素敏感个体相比，14 名（64%）胰岛素抵抗个体通过两个问卷均被发现患有 OSA 的高风险（p<0.01）。虽然一半的胰岛素抵抗个体符合 ESS 标准，存在日间过度嗜睡，但只有一名胰岛素敏感个体符合（p=0.011）。
结论
肥胖个体中胰岛素抵抗亚组中 OSA 和日间过度嗜睡的高风险很常见。基于空腹胰岛素、甘油三酯和/或 HDL-C 的胰岛素抵抗替代指标可用于帮助识别那些最需要进行 OSA 筛查和多导睡眠图转诊的肥胖成年人。
Zotero 插件