Malik Javid Ahmad, Masoodi Shariq Rashid, Shoib Sheikh
Department of Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
Indian J Endocrinol Metab. 2017 Jan-Feb;21(1):106-112. doi: 10.4103/2230-8210.196005.
Obstructive sleep apnea (OSA) and type 2 diabetes mellitus (T2DM) are two interacting epidemics both with high prevalence and morbidity. Both epidemiologic and clinical studies suggest that the majority of patients with T2DM also have OSA and untreated OSA in these patients results in poor glycemic control leading to acceleration of diabetes-related complications.
To assess the prevalence and severity of OSA in T2DM patients and to assess the impact of OSA treatment on presenting symptoms and hemoglobin A1c (HbA1c).
We performed polysomnography (PSG) studies and measured HbA1c in 62 consecutive patients with T2DM that were referred from various subspecialty clinics from July 2011 to August 2013.
In our 62 diabetic patients, 59 (95.2%) had abnormal PSG. Based on Apnea-Hypopnea Index (AHI) score, 3 (5.1%) patients had mild, 28 (47.5%) had moderate, and 28 (47.5%) had severe OSA. The mean AHI of diabetic patients was significantly more than nondiabetic patients, i.e., 25.7 versus 19.7 ( = 0.001). Variables that significantly correlated with the presence of OSA include age, gender, body mass index (BMI), hypertension, diabetes, and cardiovascular disease ( < 0.05); however, on logistic regression only BMI, hypertension, and nocturia correlated with OSA. Overall, 59% of diabetic patients showed improvement in their glycemic control as measured by HbA1c with continuous positive airway pressure (CPAP) treatment. Significant, moderate, and mild categories of treatment response were respectively observed in 7%, 20%, and 32% of patients.
Treatment of OSA with CPAP reduces HbA1c in a significant number of diabetics.
阻塞性睡眠呼吸暂停（OSA）和2型糖尿病（T2DM）是两种相互影响的流行病，发病率和患病率都很高。流行病学和临床研究均表明，大多数T2DM患者也患有OSA，这些患者中未经治疗的OSA会导致血糖控制不佳，进而加速糖尿病相关并发症的发生。
评估T2DM患者中OSA的患病率和严重程度，并评估OSA治疗对现有症状和糖化血红蛋白（HbA1c）的影响。
2011年7月至2013年8月，我们对62例从各个专科门诊转诊而来的T2DM患者进行了多导睡眠图（PSG）研究并测量了HbA1c。
在我们的62例糖尿病患者中，59例（95.2%）PSG异常。根据呼吸暂停低通气指数（AHI）评分，3例（5.1%）患者为轻度OSA，28例（47.5%）为中度OSA，28例（47.5%）为重度OSA。糖尿病患者的平均AHI显著高于非糖尿病患者，即分别为25.7和19.7（P = 0.001）。与OSA存在显著相关的变量包括年龄、性别、体重指数（BMI）、高血压、糖尿病和心血管疾病（P < 0.05）；然而，经逻辑回归分析，只有BMI、高血压和夜尿症与OSA相关。总体而言，59%的糖尿病患者在接受持续气道正压通气（CPAP）治疗后，HbA1c测量显示血糖控制得到改善。分别有7%、20%和32%的患者观察到显著、中度和轻度治疗反应。
CPAP治疗OSA可使大量糖尿病患者的HbA1c降低。
