Pamidi Sushmita, Wroblewski Kristen, Stepien Magdalena, Sharif-Sidi Khalid, Kilkus Jennifer, Whitmore Harry, Tasali Esra
1 Respiratory Division, Department of Medicine, McGill University, Montreal, Quebec, Canada; and.
2 Department of Public Health Sciences and.
Am J Respir Crit Care Med. 2015 Jul 1;192(1):96-105. doi: 10.1164/rccm.201408-1564OC.
Although obstructive sleep apnea (OSA) is associated with impaired glucose tolerance and diabetes, it remains unclear whether OSA treatment with continuous positive airway pressure (CPAP) has metabolic benefits.
To determine the effect of 8-hour nightly CPAP treatment on glucose metabolism in individuals with prediabetes and OSA.
In a randomized controlled parallel group study, 39 participants were randomly assigned to receive either 8-hour nightly CPAP (n = 26) or oral placebo (n = 13). Sleep was polysomnographically recorded in the laboratory on each night. CPAP adherence was ensured by continuous supervision. Participants continued their daily routine activities outside the laboratory. Glucose metabolism was assessed at baseline and after 2 weeks of assigned treatment using both the oral and intravenous glucose tolerance tests. The primary outcome was the overall glucose response as quantified by the area under the curve for glucose during 2-hour oral glucose tolerance testing. Secondary outcomes included fasting and 2-hour glucose and insulin, the area under the curves for insulin and insulin secretion, norepinephrine, insulin sensitivity, acute insulin response to glucose, and 24-hour blood pressure.
The overall glucose response was reduced (treatment difference: -1,276.9 [mg/dl] · min [95% confidence interval, -2,392.4 to -161.5]; P = 0.03) and insulin sensitivity was improved (treatment difference: 0.77 mU/L · min(-1) [95% confidence interval, 0.03-1.52]; P = 0.04) with CPAP as compared with placebo. Additionally, norepinephrine levels and 24-hour blood pressure were reduced with CPAP as compared with placebo.
In patients with prediabetes, 8-hour nightly CPAP treatment for 2 weeks improves glucose metabolism compared with placebo. Thus, CPAP treatment may be beneficial for metabolic risk reduction. Clinical trial registered with www.clinicaltrials.gov (NCT 01156116).
尽管阻塞性睡眠呼吸暂停（OSA）与糖耐量受损和糖尿病相关，但持续气道正压通气（CPAP）治疗OSA是否具有代谢益处仍不明确。
确定每晚8小时CPAP治疗对糖尿病前期和OSA患者糖代谢的影响。
在一项随机对照平行组研究中，39名参与者被随机分配接受每晚8小时CPAP治疗（n = 26）或口服安慰剂（n = 13）。在实验室中每晚通过多导睡眠图记录睡眠情况。通过持续监督确保CPAP依从性。参与者在实验室外继续他们的日常活动。在基线和指定治疗2周后，使用口服和静脉葡萄糖耐量试验评估糖代谢。主要结局是2小时口服葡萄糖耐量试验期间葡萄糖曲线下面积量化的总体葡萄糖反应。次要结局包括空腹和2小时血糖及胰岛素、胰岛素曲线下面积和胰岛素分泌、去甲肾上腺素、胰岛素敏感性、对葡萄糖的急性胰岛素反应以及24小时血压。
与安慰剂相比，CPAP治疗使总体葡萄糖反应降低（治疗差异：-1,276.9[mg/dl]·min[95%置信区间，-2,392.4至-161.5]；P = 0.03），胰岛素敏感性提高（治疗差异：0.77mU/L·min(-1)[95%置信区间，0.03 - 1.52]；P = 0.04）。此外，与安慰剂相比，CPAP治疗使去甲肾上腺素水平和24小时血压降低。
在糖尿病前期患者中，与安慰剂相比，每晚8小时CPAP治疗2周可改善糖代谢。因此，CPAP治疗可能有助于降低代谢风险。在www.clinicaltrials.gov注册的临床试验（NCT 01156116）。
