持续气道正压通气治疗阻塞性睡眠呼吸暂停后的心代谢变化：一项随机假对照研究。
Cardiometabolic changes after continuous positive airway pressure for obstructive sleep apnoea: a randomised sham-controlled study.
机构信息
Endocrine and Cardiometabolic Research Group, Woolcock Institute of Medical Research, University of Sydney, Glebe, Australia.
出版信息
Thorax. 2012 Dec;67(12):1081-9. doi: 10.1136/thoraxjnl-2011-201420. Epub 2012 May 5.
RATIONALE AND OBJECTIVES
Impaired insulin sensitivity (ISx), increased visceral abdominal fat (VAF) and liver fat are all central components of the metabolic syndrome and characteristics of men with obstructive sleep apnoea (OSA). The reversibility of these observed changes with continuous positive airway pressure (CPAP) treatment in men with OSA has not been systematically studied in a randomised sham-controlled fashion.
METHODS
65 men without diabetes who were CPAP naïve and had moderate to severe OSA (age=49±12 years, apnoea hypopnoea index (AHI)=39.9±17.7 events/h, body mass index=31.3±5.2 kg/m(2)) were randomised to receive either real (n=34) or sham (n=31) CPAP for 12 weeks. At 12 weeks, all subjects received real CPAP for an additional 12 weeks.
MEASUREMENTS AND MAIN RESULTS
Main outcomes were the change at week 12 from baseline in VAF, ISx and liver fat. Other metabolic outcomes were changes in the disposition index, total fat, and blood leptin and adiponectin concentrations. The AHI was lower on CPAP compared with sham by 33 events/h (95% CI-43.9 to -22.2, p<0.0001) after 12 weeks. There were no between-group differences at 12 weeks in VAF (-13.0 cm(3), -42.4 to 16.2, p=0.37), ISx (-0.13 (min(-1))(μU/ml))(-1), -0.40 to 0.14, p=0.33), liver fat (-0.5 cm(3), -3.8 to 2.7, p=0.74) or any other cardiometabolic parameter. At 24 weeks, ISx (3.2×10(4) (min(-1))(μU/ml))(-1), 0.9×10(4) to 6.0×10(4), p=0.009), but not VAF (-1.4 cm(3), -19.2 to 16.4, p=0.87) or liver fat (-0.2 Hounsfield units, -2.4 to 2.0, p=0.83) were improved compared with baseline in the whole study group.
CONCLUSION
Reducing visceral adiposity in men with OSA cannot be achieved with CPAP alone and is likely to require weight-loss interventions. Longer-term effects of CPAP on other cardiometabolic markers such as ISx require further investigation to fully examine time dependencies.
TRIAL REGISTRATION NUMBER
ACTRN12608000301369.
背景与目的
胰岛素敏感性降低（ISx）、内脏腹部脂肪（VAF）增加和肝脂肪均为代谢综合征的核心组成部分，也是阻塞性睡眠呼吸暂停（OSA）男性的特征。尚未以随机、假对照的方式系统研究 OSA 男性经持续气道正压通气（CPAP）治疗后这些观察到的变化是否具有可逆性。
方法
65 名未接受 CPAP 治疗且患有中度至重度 OSA（年龄=49±12 岁，呼吸暂停低通气指数（AHI）=39.9±17.7 次/小时，体重指数=31.3±5.2kg/m2）且无糖尿病的男性被随机分为两组，分别接受真 CPAP（n=34）或假 CPAP（n=31）治疗 12 周。12 周后，所有患者均接受真 CPAP 治疗 12 周。
测量与主要结果
主要结局为从基线到第 12 周时 VAF、ISx 和肝脂肪的变化。其他代谢结局为处理指数、总脂肪以及血瘦素和脂联素浓度的变化。CPAP 治疗 12 周后，与假 CPAP 相比，AHI 降低了 33 次/小时（95%CI-43.9 至-22.2，p<0.0001）。12 周时，VAF（-13.0cm3，-42.4 至 16.2，p=0.37）、ISx（-0.13（min-1）（μU/ml）-1，-0.40 至 0.14，p=0.33）、肝脂肪（-0.5cm3，-3.8 至 2.7，p=0.74）或任何其他心血管代谢参数在两组间均无差异。24 周时，ISx（3.2×104（min-1）（μU/ml）-1，0.9×104 至 6.0×104，p=0.009），但 VAF（-1.4cm3，-19.2 至 16.4，p=0.87）或肝脂肪（-0.2 个 Hounsfield 单位，-2.4 至 2.0，p=0.83）与基线相比均有改善。
结论
仅用 CPAP 无法减少 OSA 男性的内脏脂肪，可能需要减肥干预。CPAP 对 ISx 等其他心血管代谢标志物的长期影响需要进一步研究，以全面检查时间依赖性。
试验注册号
ACTRN12608000301369。
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