Department of Medical Sciences and Rehabilitation, Istituto Auxologico Italiano, Milan, Italy.
PLoS One. 2013 Apr 17;8(4):e61382. doi: 10.1371/journal.pone.0061382. Print 2013.
The association of obstructive sleep apnea (OSA) with glucose intolerance and the beneficial effect of lifestyle intervention have been poorly investigated in women particularly before menopausal status. The study explored 1) whether OSA is associated with impaired glucose homeostasis in obese non diabetic premenopausal and menopausal women and 2) the effects of a 3- month lifestyle intervention on glucose homeostasis in OSA women.
We consecutively recruited 98 obese women (39 premenopausal) from those referred for a weight loss intervention. Ambulatory nocturnal polysomnography, body composition, oral glucose tolerance test, insulin sensitivity and β cell function were assessed before and after intervention.
41% of premenopausal and 64% of menopausal women had OSA which was associated with worse glucose homeostasis before menopausal status. Mean and minimal nocturnal oxygen saturation (SaO2) was associated with neck/height ratio (NHR), independently of total and central obesity. Mean and minimal nocturnal SaO2 and NHR were correlated with insulin sensitivity and fasting glucose. In multivariate analyses, nocturnal mean SaO2 was negatively and independently correlated with fasting glucose (p<0.0001) and NHR with insulin sensitivity (p<0.0001). In OSA women, the intervention induced a 5% weight reduction and a significant increase in minimal nocturnal SaO2, insulin sensitivity and β cell function. Changes in fasting glucose and insulin sensitivity were associated with those in minimal nocturnal SaO2 (p<0.05) and not with weight loss.
In obese women, glucose homeostasis worsens due to nocturnal hypoxia and increased neck circumference through mechanisms partially independent of obesity. OSA is more clearly associated with glucose intolerance in premenopausal than in menopausal women. In OSA women, the improvement of nocturnal hypoxia induced by lifestyle modifications is associated with that of glucose homeostasis.
阻塞性睡眠呼吸暂停（OSA）与葡萄糖耐量受损以及生活方式干预的有益影响在女性中，尤其是在绝经前状态下，研究得很少。本研究探讨了 1）OSA 是否与肥胖非糖尿病绝经前和绝经后女性葡萄糖稳态受损有关，以及 2）3 个月生活方式干预对 OSA 女性葡萄糖稳态的影响。
我们连续招募了 98 名肥胖女性（39 名绝经前），这些女性是因减肥干预而被转介过来的。在干预前后评估了动态夜间多导睡眠图、身体成分、口服葡萄糖耐量试验、胰岛素敏感性和β细胞功能。
41%的绝经前和 64%的绝经后女性患有 OSA，这与绝经前状态下葡萄糖稳态较差有关。平均和最小夜间血氧饱和度（SaO2）与颈高比（NHR）相关，与总肥胖和中心肥胖无关。平均和最小夜间 SaO2 和 NHR 与胰岛素敏感性和空腹血糖相关。在多变量分析中，夜间平均 SaO2 与空腹血糖呈负相关且独立相关（p<0.0001），NHR 与胰岛素敏感性呈负相关（p<0.0001）。在 OSA 女性中，干预导致体重减轻 5%，夜间最小 SaO2、胰岛素敏感性和β细胞功能显著增加。空腹血糖和胰岛素敏感性的变化与最小夜间 SaO2 的变化相关（p<0.05），而与体重减轻无关。
在肥胖女性中，由于夜间缺氧和颈围增加，葡萄糖稳态恶化，其机制部分独立于肥胖。OSA 与绝经前女性的葡萄糖不耐受关系更为密切，而与绝经后女性的关系不太密切。在 OSA 女性中，生活方式改变引起的夜间缺氧改善与葡萄糖稳态改善相关。
