阻塞性睡眠呼吸暂停的主要特征与糖代谢之间的独立关系：一项横断面研究。
Independent relationships between cardinal features of obstructive sleep apnea and glycometabolism: a cross-sectional study.
机构信息
Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China; Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai 200233, China.
Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China; Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai 200233, China.
出版信息
Metabolism. 2018 Aug;85:340-347. doi: 10.1016/j.metabol.2017.11.021. Epub 2018 Feb 1.
BACKGROUND
Obstructive sleep apnea (OSA) is associated with abnormal glycometabolism; however, the cardinal features of OSA, such as sleep fragmentation (SF) and intermittent hypoxia (IH), have yet to show clear, independent associations with glycometabolism.
METHODS
We enrolled 1834 participants with suspected OSA from July 2008 to July 2013 to participate in this study. Polysomnographic variables, biochemical indicators, and physical measurements were collected for each participant. Multiple linear regression analyses were used to evaluate independent associations between cardinal features of OSA and glycometabolism. Logistic regressions were used to determine the odds ratios (ORs) for abnormal glucose metabolism across microarousal index (MAI) and oxygen desaturation index (ODI) quartiles. The effect of the interaction between MAI and ODI on glycometabolism was also evaluated.
RESULTS
The MAI was independently associated with fasting insulin levels (β = 0.024, p = 0.001) and the homeostasis model assessment of insulin resistance (HOMA-IR; β = 0.006, p = 0.002) after multiple adjustments of confounding factors. In addition, the ORs for hyperinsulinemia across higher MAI quartiles were 1.081, 1.349, and 1.656, compared with the lowest quartile (p = 0.015 for a linear trend). Similarly, the ODI was independently associated with fasting glucose levels (β = 0.003, p < 0.001), fasting insulin levels (β = 0.037, p < 0.001), and the HOMA-IR (β = 0.010, p < 0.001) after adjusting for multiple factors. The ORs for hyperglycemia across higher ODI quartiles were 1.362, 1.231, and 2.184, compared with the lowest quartile (p < 0.05 for a linear trend). In addition, the ORs for hyperinsulinemia and abnormal HOMA-IR across ODI quartiles had the same trends. There was no interaction between MAI and ODI with respect to glycometabolism.
CONCLUSION
SF was independently associated with hyperinsulinemia, and IH was independently associated with hyperglycemia, hyperinsulinemia, and an abnormal HOMA-IR. We found no interaction between SF and IH with respect to OSA-related abnormal glycometabolism.
背景
阻塞性睡眠呼吸暂停（OSA）与异常糖代谢有关；然而，OSA 的主要特征，如睡眠片段化（SF）和间歇性低氧（IH），与糖代谢之间尚未显示出明确的、独立的关联。
方法
我们招募了 1834 名疑似 OSA 的参与者，从 2008 年 7 月至 2013 年 7 月参加了这项研究。为每位参与者收集了多导睡眠图变量、生化指标和身体测量值。采用多元线性回归分析评估 OSA 主要特征与糖代谢之间的独立关联。采用逻辑回归确定微觉醒指数（MAI）和氧减指数（ODI）四分位数的异常葡萄糖代谢的比值比（OR）。还评估了 MAI 和 ODI 之间的交互作用对糖代谢的影响。
结果
在对混杂因素进行多次调整后，MAI 与空腹胰岛素水平（β=0.024，p=0.001）和胰岛素抵抗稳态模型评估（HOMA-IR；β=0.006，p=0.002）独立相关。此外，与最低四分位数相比，较高 MAI 四分位数的高胰岛素血症的 OR 分别为 1.081、1.349 和 1.656（p=0.015 线性趋势）。同样，ODI 与空腹血糖水平（β=0.003，p<0.001）、空腹胰岛素水平（β=0.037，p<0.001）和 HOMA-IR（β=0.010，p<0.001）独立相关在调整多个因素后。与最低四分位数相比，较高 ODI 四分位数的高血糖的 OR 分别为 1.362、1.231 和 2.184（p<0.05 线性趋势）。此外，ODI 四分位数的高胰岛素血症和异常 HOMA-IR 的 OR 也呈现相同的趋势。MAI 和 ODI 之间在糖代谢方面没有交互作用。
结论
SF 与高胰岛素血症独立相关，IH 与高血糖、高胰岛素血症和异常 HOMA-IR 独立相关。我们没有发现 SF 和 IH 之间在 OSA 相关的异常糖代谢方面存在交互作用。
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