Shechter Ari
Department of Medicine, Columbia University, New York, NY, USA
Eur Respir J. 2016 Dec;48(6):1640-1657. doi: 10.1183/13993003.00689-2016. Epub 2016 Oct 20.
Obesity is both a cause and a possible consequence of obstructive sleep apnoea (OSA), as OSA seems to affect parameters involved in energy balance regulation, including food intake, hormonal regulation of hunger/satiety, energy metabolism and physical activity. It is known that weight loss improves OSA, yet it remains unclear why continuous positive airway pressure (CPAP) often results in weight gain.The goal of this systematic review is to explore if and how CPAP affects the behaviour and/or metabolism involved in regulating energy balance.CPAP appears to correct for a hormonal profile characterised by abnormally high leptin and ghrelin levels in OSA, by reducing the circulating levels of each. This is expected to reduce excess food intake. However, reliable measures of food intake are lacking, and not yet sufficient to make conclusions. Although studies are limited and inconsistent, CPAP may alter energy metabolism, with reports of reductions in resting metabolic rate or sleeping metabolic rate. CPAP appears to not have an appreciable effect on altering physical activity levels. More work is needed to characterise how CPAP affects energy balance regulation.It is clear that promoting CPAP in conjunction with other weight loss approaches should be used to encourage optimal outcomes in OSA patients.
肥胖既是阻塞性睡眠呼吸暂停（OSA）的一个病因，也是其一个可能的后果，因为OSA似乎会影响能量平衡调节所涉及的参数，包括食物摄入、饥饿/饱腹感的激素调节、能量代谢和身体活动。众所周知，体重减轻可改善OSA，但持续气道正压通气（CPAP）为何常常导致体重增加仍不清楚。本系统评价的目的是探讨CPAP是否以及如何影响调节能量平衡的行为和/或代谢。CPAP似乎可通过降低OSA患者体内瘦素和胃饥饿素的循环水平，来纠正以这两种激素水平异常升高为特征的激素谱。这有望减少过量的食物摄入。然而，目前缺乏可靠的食物摄入量测量方法，尚不足以得出结论。尽管研究有限且结果不一致，但CPAP可能会改变能量代谢，有报告称静息代谢率或睡眠代谢率降低。CPAP似乎对改变身体活动水平没有明显影响。需要开展更多工作来明确CPAP如何影响能量平衡调节。显然，应将推广CPAP与其他减肥方法相结合，以促使OSA患者获得最佳治疗效果。
