Department of Internal Medicine, Hokuriku Central Hospital, Toyama, Japan.
Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
J Diabetes Res. 2018 Oct 22;2018:1567683. doi: 10.1155/2018/1567683. eCollection 2018.
Individuals with multiple metabolic risk factors often experience concomitant sleep-disordered breathing (SDB). We aimed to determine the associations of SDB with individual components of metabolic syndrome independent of obesity.
A cross-sectional study was conducted in 1137 employees aged 30-64 years. Apnea-hypopnea index (AHI) was assessed using a portable monitor for obstructive sleep apnea by admission. Of these, 451 participants took an oral glucose tolerance test to assess homeostatic model assessment of insulin resistance (HOMA-IR) and Matsuda insulin sensitivity index (ISI).
The odds ratio (OR) of the highest category of the AHI (≥15 episodes per hour) compared to the lowest one (<5 episodes per hour) was significantly elevated for hypertension, for hypertriglyceridemia, and for low HDL-cholesterolemia when adjusted for age, sex, and alcohol and smoking status ( < 0.05). After further adjustment for body mass index (BMI) or waist circumference, the associations for hypertension still remained statistically significant ( < 0.05) while those for hypertriglyceridemia and low HDL-cholesterolemia were no longer significant. The association between higher insulin resistance as assessed by HOMA-IR and Matsuda ISI and higher categories of the AHI was also lost after adjustment for BMI.
Obesity was a strong confounding factor in the association between SDB and most metabolic risk factors including insulin resistance, except for hypertension. Further longitudinal study is needed to examine the temporal or causal relationships between SDB and metabolic risk factors. This trial is registered with UMIN-CTR UMIN000028067.
患有多种代谢风险因素的个体通常伴有睡眠呼吸障碍（SDB）。我们旨在确定 SDB 与代谢综合征的个体成分之间的关联，而不考虑肥胖。
对 1137 名年龄在 30-64 岁的员工进行了一项横断面研究。入院时使用便携式监测仪评估阻塞性睡眠呼吸暂停的呼吸暂停低通气指数（AHI）。其中，451 名参与者接受了口服葡萄糖耐量试验，以评估稳态模型评估的胰岛素抵抗（HOMA-IR）和 Matsuda 胰岛素敏感性指数（ISI）。
与最低 AHI （<5 次/小时）组相比，最高 AHI （≥15 次/小时）组的高血压、高三酰甘油血症和低高密度脂蛋白血症的比值比（OR）显著升高，调整年龄、性别、酒精和吸烟状况后（<0.05）。进一步调整体重指数（BMI）或腰围后，高血压的相关性仍具有统计学意义（<0.05），而高三酰甘油血症和低高密度脂蛋白血症的相关性则不再显著。HOMA-IR 和 Matsuda ISI 评估的胰岛素抵抗与 AHI 较高类别之间的关联，在调整 BMI 后也消失了。
肥胖是 SDB 与包括胰岛素抵抗在内的大多数代谢风险因素之间关联的一个强有力的混杂因素，除了高血压。需要进一步的纵向研究来检验 SDB 和代谢风险因素之间的时间或因果关系。该试验在 UMIN-CTR UMIN000028067 注册。
