Shechter Ari, Foster Gary D, Lang Wei, Reboussin David M, St-Onge Marie-Pierre, Zammit Gary, Newman Anne B, Millman Richard P, Wadden Thomas A, Jakicic John M, Strotmeyer Elsa S, Wing Rena R, Pi-Sunyer F Xavier, Kuna Samuel T
Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University, New York, NY, USA.
Center for Weight and Eating Disorders, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
J Sleep Res. 2017 Dec;26(6):747-755. doi: 10.1111/jsr.12559. Epub 2017 May 31.
The aim of this study was to determine if an intensive lifestyle intervention (ILI) reduces the severity of obstructive sleep apnea (OSA) in rapid-eye movement (REM) sleep, and to determine if longitudinal changes in glycaemic control are related to changes in OSA severity during REM sleep over a 4-year follow-up. This was a randomized controlled trial including 264 overweight/obese adults with type 2 diabetes (T2D) and OSA. Participants were randomized to an ILI targeted to weight loss or a diabetes support and education (DSE) control group. Measures included anthropometry, apnea-hypopnea index (AHI) during REM sleep (REM-AHI) and non-REM sleep (NREM-AHI) and glycated haemoglobin (HbA1c) at baseline and year 1, year 2 and year 4 follow-ups. Mean baseline values of REM-AHI were significantly higher than NREM-AHI in both groups. Both REM-AHI and NREM-AHI were reduced significantly more in ILI versus DSE, but these differences were attenuated slightly after adjustment for weight changes. Repeated-measure mixed-model analyses including data to year 4 demonstrated that changes in HbA1c were related significantly to changes in weight, but not to changes in REM-AHI and NREM-AHI. Compared to control, the ILI reduced REM-AHI and NREM-AHI during the 4-year follow-up. Weight, as opposed to REM-AHI and NREM-AHI, was related to changes in HbA1c. The findings imply that weight loss from a lifestyle intervention is more important than reductions in AHI for improving glycaemic control in T2D patients with OSA.
本研究的目的是确定强化生活方式干预（ILI）是否能降低快速眼动（REM）睡眠期阻塞性睡眠呼吸暂停（OSA）的严重程度，并确定在4年的随访中，血糖控制的纵向变化是否与REM睡眠期OSA严重程度的变化相关。这是一项随机对照试验，纳入了264名患有2型糖尿病（T2D）和OSA的超重/肥胖成年人。参与者被随机分配到以减肥为目标的ILI组或糖尿病支持与教育（DSE）对照组。测量指标包括人体测量学指标、REM睡眠期呼吸暂停低通气指数（AHI）（REM-AHI）和非REM睡眠期呼吸暂停低通气指数（NREM-AHI），以及基线时、随访第1年、第2年和第4年的糖化血红蛋白（HbA1c）。两组的REM-AHI平均基线值均显著高于NREM-AHI。与DSE组相比，ILI组的REM-AHI和NREM-AHI均显著降低，但在对体重变化进行调整后，这些差异略有减弱。包括第4年数据的重复测量混合模型分析表明，HbA1c的变化与体重变化显著相关，但与REM-AHI和NREM-AHI的变化无关。与对照组相比，ILI组在4年随访期间降低了REM-AHI和NREM-AHI。与REM-AHI和NREM-AHI不同，体重与HbA1c的变化相关。研究结果表明，对于改善患有OSA的T2D患者的血糖控制，生活方式干预导致的体重减轻比AHI的降低更重要。
