aCentre of Endocrinology, Diabetes and Metabolism, University of Birmingham bDepartment of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham cDepartment of Respiratory Medicine, University Hospital of Coventry and Warwickshire, Coventry, West Midlands, UK.
Curr Opin Pulm Med. 2013 Nov;19(6):631-8. doi: 10.1097/MCP.0b013e3283659da5.
The relationship between obstructive sleep apnoea (OSA) and dysglycaemia is well established. However, uncertainty remains as to the extent that obesity mediates this relationship. The impact of OSA treatment on glucose metabolism and the consequences of having OSA in patients with diabetes is unclear. This review aims to summarize the latest evidence regarding the links between OSA and dysglycaemia.
OSA is associated with insulin resistance in lean individuals and predicts insulin resistance worsening longitudinally. Continuous positive airway pressure (CPAP) lowers insulin resistance in CPAP-compliant patients. OSA is associated with impaired β-cell function. In patients with type 2 diabetes (T2D), the association between OSA and glycosylated haemoglobin (HbA1c) is related to nocturnal hypoxaemia. Apnoea hypopnoea index (AHI) during rapid eye movement (REM) (not non-REM) sleep is associated with HbA1c. In-laboratory, supervised CPAP improves glycaemia. OSA is associated with and predicts the progression of some diabetic vascular complications. Intensive lifestyle intervention in patients with T2D improves OSA independent of weight loss.
OSA is associated with insulin resistance and β-cell dysfunction independent of obesity. OSA is associated with HbA1c and vascular complications in patients with T2D. CPAP might improve insulin resistance and glycaemic measures. Lifestyle intervention has a significant impact on AHI in patients with T2D.
目的综述：阻塞性睡眠呼吸暂停（OSA）与糖代谢紊乱之间的关系已得到充分证实。然而，肥胖在多大程度上介导这种关系仍存在不确定性。OSA 治疗对葡萄糖代谢的影响以及糖尿病患者中存在 OSA 的后果尚不清楚。本综述旨在总结有关 OSA 与糖代谢紊乱之间联系的最新证据。
最近发现：OSA 与瘦个体的胰岛素抵抗有关，并预测胰岛素抵抗随时间恶化。持续气道正压通气（CPAP）可降低 CPAP 依从性患者的胰岛素抵抗。OSA 与β细胞功能障碍有关。在 2 型糖尿病（T2D）患者中，OSA 与糖化血红蛋白（HbA1c）之间的关联与夜间低氧血症有关。快速眼动（REM）睡眠期间的呼吸暂停低通气指数（AHI）（而非非 REM 睡眠期间）与 HbA1c 相关。在实验室中，经监督的 CPAP 可改善血糖。OSA 与某些糖尿病血管并发症的进展有关并可预测其进展。T2D 患者的强化生活方式干预可改善 OSA，而与体重减轻无关。
总结：OSA 与肥胖无关，与胰岛素抵抗和β细胞功能障碍有关。OSA 与 T2D 患者的 HbA1c 和血管并发症有关。CPAP 可能改善胰岛素抵抗和血糖指标。生活方式干预对 T2D 患者的 AHI 有重大影响。
