夜间低氧血症导致阻塞性睡眠呼吸暂停合并2型糖尿病患者出现高血糖。

Nocturnal Hypoxemia Causes Hyperglycemia in Patients With Obstructive Sleep Apnea and Type 2 Diabetes Mellitus.

作者信息

Hui Peilin, Zhao Lijun, Xie Yuping, Wei Xiaoquan, Ma Wei, Wang Jinfeng, Hou Yiping, Ning Jing, Zhou Liya, Guo Qian, Zhou Shuhong

机构信息

Sleep Medicine Center of Gansu Province, Gansu Provincial Hospital, Lanzhou, Gansu, China.

出版信息

Am J Med Sci. 2016 Feb;351(2):160-8. doi: 10.1016/j.amjms.2015.12.002.

DOI:10.1016/j.amjms.2015.12.002

PMID:26897271

Abstract

BACKGROUND

Our purpose was to investigate the relationship between oxygen saturation (SpO2) and dynamic interstitial glucose level (IGL) in patients with obstructive sleep apnea (OSA) along with type 2 diabetes mellitus (T2DM), and to investigate the potential mechanisms thereof.

MATERIALS AND METHODS

A total of 130 patients with OSA and T2DM underwent polysomnography and oral glucose tolerance tests at the Sleep Medicine Center. Using the lowest (L) SpO2% tested, patients were divided into mild, moderate and severe LSpO2 groups. Polysomnography and continuous glucose monitoring systems were used to analyze the altered pattern of SpO2 and dynamic IGL in the 3 groups.

RESULTS

LSpO2 during sleep in patients with OSA and T2DM stimulated an increase in IGL. The moderate and severe levels were represented by IGL45 and IGL30, respectively. The average nocturnal and peak IGL after LSpO2 in the severe group were significantly higher than in the mild and moderate groups. Stepwise multiple regression analysis showed that the body mass index (β = 0.301, P < 0.001), homeostatic model assessment of insulin resistance (β = 0.260, P < 0.001), apnea-hypopnea index (β = 0.309, P < 0.001), average SpO2 (β = -0.423, P = 0.008), LSpO2 (β = -0.369, P < 0.001) and microarousal index (β = 0.335, P = 0.044) were probably related to nocturnal IGL in patients with OSA along with T2DM.

CONCLUSIONS

Severe and moderate OSA with T2DM is marked by a delayed IGL peak following LSpO2. Nocturnal hypoxemia causes hyperglycemia in patients with OSA along with T2DM.

摘要

背景

我们的目的是研究阻塞性睡眠呼吸暂停（OSA）合并2型糖尿病（T2DM）患者的血氧饱和度（SpO2）与动态组织间葡萄糖水平（IGL）之间的关系，并探究其潜在机制。

材料与方法

共有130例OSA合并T2DM患者在睡眠医学中心接受了多导睡眠图检查和口服葡萄糖耐量试验。根据检测到的最低SpO2%（LSpO2），将患者分为轻度、中度和重度LSpO2组。采用多导睡眠图和连续血糖监测系统分析3组患者SpO2和动态IGL的变化模式。

结果

OSA合并T2DM患者睡眠期间的LSpO2会刺激IGL升高。中度和重度水平分别以IGL45和IGL30表示。重度组LSpO2后的平均夜间IGL和IGL峰值显著高于轻度和中度组。逐步多元回归分析显示，体重指数（β = 0.301，P < 0.001）、胰岛素抵抗稳态模型评估（β = 0.260，P < 0.001）、呼吸暂停低通气指数（β = 0.309，P < 0.001）、平均SpO2（β = -0.423，P = 0.008）、LSpO2（β = -0.369，P < 0.001）和微觉醒指数（β = 0.335，P = 0.044）可能与OSA合并T2DM患者的夜间IGL有关。