气道正压通气治疗对男性阻塞性睡眠呼吸暂停患者心血管及代谢指标的影响

Effects of positive airway pressure therapy on cardiovascular and metabolic markers in males with obstructive sleep apnea.

作者信息

Feliciano A, Oliveira M J, Cysneiros A, Martinho C, Reis R P, Penque D, Pinto P, Bárbara C

机构信息

Pneumology in Thorax Department, Centro Hospitalar Lisboa Norte, Lisboa, Portugal; Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal.

Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia e Espinho, EPE, Vila Nova de Gaia, Portugal.

出版信息

Rev Port Pneumol (2006). 2017 Jul-Aug;23(4):193-202. doi: 10.1016/j.rppnen.2017.02.010. Epub 2017 Jun 7.

DOI:10.1016/j.rppnen.2017.02.010

PMID:28596012

Abstract

INTRODUCTION

Obstructive sleep apnea syndrome (OSAS) is associated with cardiovascular/metabolic complications. Some analytical parameters (homocysteine, glycemic and lipidic profiles) are recognized markers of these consequences. Limited data is available on the association of these markers and OSAS's severity/response to positive airway pressure therapy (PAP).

MATERIAL AND METHODS

In this prospective study we analyzed polysomnographic and analytical data of male patients admitted to sleep laboratory. The aim was to evaluate metabolic/cardiovascular markers in snorers and OSAS patients, to relate with sleep parameters and PAP response. One-hundred and three patients were included, and 73 (71%) were OSAS patients. OSAS patients were similar to snorers except for higher body mass index (BMI) and dyslipidemia. Severe OSAS patients showed higher glycemia, HbA1c, insulin, and insulin resistance, and lower HDL cholesterol in comparison to mild-moderate (p<0.05, p<0.05, p<0.001, p<0.001, p<0.05, respectively). Glycemic profile and triglycerides were slightly correlated with OSAS severity. 46 OSAS patients were submitted to 6 months of PAP, with a statistical decrease in mean values of homocysteine, glycemia, total and LDL cholesterol (p<0.05, p<0.05, p<0.05, respectively), and in glycemia and LDL cholesterol in severe group only (p<0.05, p<0.05, respectively).

RESULTS

This study demonstrated an association between glucose metabolism parameters and triglycerides with OSAS severity underlying the complexity of the process leading to cardiovascular/metabolic complications in this disorder. Moreover, homocysteine, glycemic and lipidic profiles changed significantly after 6 months of PAP therapy in OSAS, supporting its cardiovascular and metabolic protective effect.

CONCLUSION

Our study has reinforced the importance of analytical cardiovascular/metabolic evaluation as complementary tool of diagnosis/treatment response in OSAS.

摘要

引言

阻塞性睡眠呼吸暂停综合征（OSAS）与心血管/代谢并发症相关。一些分析参数（同型半胱氨酸、血糖和血脂谱）是这些后果的公认标志物。关于这些标志物与OSAS严重程度/对气道正压通气治疗（PAP）反应之间关联的数据有限。

材料与方法

在这项前瞻性研究中，我们分析了入住睡眠实验室的男性患者的多导睡眠图和分析数据。目的是评估打鼾者和OSAS患者的代谢/心血管标志物，将其与睡眠参数和PAP反应相关联。纳入了103例患者，其中73例（71%）为OSAS患者。除了较高的体重指数（BMI）和血脂异常外，OSAS患者与打鼾者相似。与轻度至中度OSAS患者相比，重度OSAS患者的血糖、糖化血红蛋白、胰岛素和胰岛素抵抗更高，高密度脂蛋白胆固醇更低（分别为p<0.05、p<0.05、p<0.001、p<0.001、p<0.05）。血糖谱和甘油三酯与OSAS严重程度略有相关。46例OSAS患者接受了6个月的PAP治疗，同型半胱氨酸、血糖、总胆固醇和低密度脂蛋白胆固醇的平均值有统计学下降（分别为p<0.05、p<0.05、p<0.05），仅重度组的血糖和低密度脂蛋白胆固醇下降（分别为p<0.05、p<0.05）。