阻塞性睡眠呼吸暂停患者脂蛋白浓度异常与胰岛素抵抗有关。
Abnormalities of lipoprotein concentrations in obstructive sleep apnea are related to insulin resistance.
作者信息
Liu Alice, Cardell James, Ariel Danit, Lamendola Cindy, Abbasi Fahim, Kim Sun H, Holmes Tyson H, Tomasso Vanessa, Mojaddidi Hafasa, Grove Kaylene, Kushida Clete A, Reaven Gerald M
机构信息
Department of Medicine, Stanford University School of Medicine, Stanford, CA.
Stanford Sleep Medicine Center, Stanford University School of Medicine, Stanford, CA.
出版信息
Sleep. 2015 May 1;38(5):793-9. doi: 10.5665/sleep.4678.
STUDY OBJECTIVE
Prevalence of cardiovascular disease (CVD) is increased in patients with obstructive sleep apnea (OSA), possibly related to dyslipidemia in these individuals. Insulin resistance is also common in OSA, but its contribution to dyslipidemia of OSA is unclear. The study's aim was to define the relationships among abnormalities of lipoprotein metabolism, clinical measures of OSA, and insulin resistance.
DESIGN
Cross-sectional study. OSA severity was defined by the apnea-hypopnea index (AHI) during polysomnography. Hypoxia measures were expressed as minimum and mean oxygen saturation, and the oxygen desaturation index. Insulin resistance was quantified by determining steady-state plasma glucose (SSPG) concentrations during the insulin suppression test. Fasting plasma lipid/lipoprotein evaluation was performed by vertical auto profile methodology.
SETTING
Academic medical center.
PARTICIPANTS
107 nondiabetic, overweight/obese adults.
MEASUREMENTS AND RESULTS
Lipoprotein particles did not correlate with AHI or any hypoxia measures, nor were there differences noted by categories of OSA severity. By contrast, even after adjustment for age, sex, and BMI, SSPG was positively correlated with triglycerides (r = 0.30, P < 0.01), very low density lipoprotein (VLDL) and its subclasses (VLDL1+2) (r = 0.21-0.23, P < 0.05), and low density lipoprotein subclass 4 (LDL4) (r = 0.30, P < 0.01). SSPG was negatively correlated with high density lipoprotein (HDL) (r = -0.38, P < 0.001) and its subclasses (HDL2 and HDL3) (r = -0.32, -0.43, P < 0.01), and apolipoprotein A1 (r = -0.33, P < 0.01). Linear trends of these lipoprotein concentrations across SSPG tertiles were also significant.
CONCLUSIONS
Pro-atherogenic lipoprotein abnormalities in obstructive sleep apnea (OSA) are related to insulin resistance, but not to OSA severity or degree of hypoxia. Insulin resistance may represent the link between OSA-related dyslipidemia and increased cardiovascular disease risk.
研究目的
阻塞性睡眠呼吸暂停（OSA）患者心血管疾病（CVD）的患病率增加，这可能与这些个体的血脂异常有关。胰岛素抵抗在OSA中也很常见，但其对OSA血脂异常的影响尚不清楚。本研究的目的是确定脂蛋白代谢异常、OSA的临床指标和胰岛素抵抗之间的关系。
设计
横断面研究。OSA严重程度通过多导睡眠图期间的呼吸暂停低通气指数（AHI）来定义。低氧指标用最低和平均血氧饱和度以及氧去饱和指数表示。胰岛素抵抗通过在胰岛素抑制试验期间测定稳态血浆葡萄糖（SSPG）浓度来量化。空腹血浆脂质/脂蛋白评估采用垂直自动分析方法进行。
地点
学术医疗中心。
参与者
107名非糖尿病、超重/肥胖成年人。
测量与结果
脂蛋白颗粒与AHI或任何低氧指标均无相关性，OSA严重程度类别之间也未观察到差异。相比之下，即使在调整年龄、性别和BMI后，SSPG仍与甘油三酯（r = 0.30，P < 0.01）、极低密度脂蛋白（VLDL）及其亚类（VLDL1 + 2）（r = 0.21 - 0.23，P < 0.05）以及低密度脂蛋白亚类4（LDL4）（r = 0.30，P < 0.01）呈正相关。SSPG与高密度脂蛋白（HDL）（r = -0.38，P < 0.001）及其亚类（HDL2和HDL3）（r = -0.32，-0.43，P < 0.01）以及载脂蛋白A1（r = -0.33，P < 0.01）呈负相关。这些脂蛋白浓度在SSPG三分位数中的线性趋势也很显著。
结论
阻塞性睡眠呼吸暂停（OSA）中促动脉粥样硬化的脂蛋白异常与胰岛素抵抗有关，但与OSA严重程度或低氧程度无关。胰岛素抵抗可能代表了OSA相关血脂异常与心血管疾病风险增加之间的联系。
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