Chihara Yuichi, Akamizu Takashi, Azuma Masanori, Murase Kimihiko, Harada Yuka, Tanizawa Kiminobu, Handa Tomohiro, Oga Toru, Mishima Michiaki, Chin Kazuo
Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
The First Department of Medicine, Wakayama Medical University, Wakayama, Japan.
J Clin Sleep Med. 2015 Aug 15;11(8):895-905. doi: 10.5664/jcsm.4942.
There are reports suggesting that obstructive sleep apnea (OSA) may itself cause weight gain. However, recent reports showed increases in body mass index (BMI) following continuous positive airway pressure (CPAP) treatments. When considering weight changes, changes in humoral factors that have significant effects on appetite such as acyl (AG) and desacyl ghrelin (DAG), leptin, insulin, and glucose and their interactions, examples of which are AG/DAG and AG/insulin, are important. The aim of this study was to test the hypothesis that some appetite-related factors had a specific profile before and after CPAP treatment.
Metabolic parameters were measured cross-sectionally while fasting and 30, 60, 90, and 120 min following breakfast in no or mild OSA (apnea-hypopnea index < 15, n = 15) and moderate-to-severe OSA (apnea-hypopnea index ≥ 15, n = 39) participants in a single institute. There were no differences in age, sex, BMI, or visceral fat accumulation between the two groups. Twenty-one patients with moderate-to-severe OSA who received CPAP treatment also prospectively underwent the same testing following 3 months of CPAP treatment.
Although fasting and postprandial glucose, insulin, and leptin levels did not differ between no or mild OSA and moderate-to-severe OSA participants, AG and DAG, including AG/DAG and AG/insulin, under fasting and postprandial conditions were significantly increased in the moderate-to-severe OSA patients (p < 0.01). After 3 months of CPAP treatment in 21 of the moderate-to-severe OSA participants, AG/DAG did not change significantly, but other ghrelin-related parameters including AG/insulin significantly decreased compared with values before treatment but remained higher than in no or mild OSA.
Among several important metabolic factors, ghrelin-related factors had the strongest associations with moderate-to-severe OSA. These results indicate that continuous changes in ghrelin secretion in OSA patients existed at least within 3 months of CPAP treatment. Methods to prevent OSA as well as treatment in its early stage may be recommended.
有报告表明阻塞性睡眠呼吸暂停（OSA）本身可能导致体重增加。然而，最近的报告显示持续气道正压通气（CPAP）治疗后体重指数（BMI）有所增加。在考虑体重变化时，对食欲有显著影响的体液因素的变化很重要，如酰基胃饥饿素（AG）和去酰基胃饥饿素（DAG）、瘦素、胰岛素、葡萄糖及其相互作用，例如AG/DAG和AG/胰岛素。本研究的目的是检验以下假设：一些与食欲相关的因素在CPAP治疗前后具有特定特征。
在一家单一机构中，对无或轻度OSA（呼吸暂停低通气指数<15，n = 15）和中重度OSA（呼吸暂停低通气指数≥15，n = 39）参与者在空腹时以及早餐后30、60、90和120分钟进行横断面代谢参数测量。两组在年龄、性别、BMI或内脏脂肪堆积方面无差异。21名接受CPAP治疗的中重度OSA患者在CPAP治疗3个月后也前瞻性地接受了相同的测试。
尽管无或轻度OSA与中重度OSA参与者的空腹和餐后血糖、胰岛素和瘦素水平没有差异，但中重度OSA患者在空腹和餐后条件下的AG和DAG，包括AG/DAG和AG/胰岛素，显著升高（p < 0.01）。21名中重度OSA参与者接受CPAP治疗3个月后，AG/DAG没有显著变化，但与治疗前相比，其他与胃饥饿素相关的参数，包括AG/胰岛素，显著降低，但仍高于无或轻度OSA患者。
在几个重要的代谢因素中，与胃饥饿素相关的因素与中重度OSA的关联最强。这些结果表明，OSA患者胃饥饿素分泌的持续变化至少在CPAP治疗的3个月内存在。可能建议采取预防OSA的方法以及早期治疗。
