Isobe Yuki, Nakatsumi Yasuto, Sugiyama Yu, Hamaoka Takuto, Murai Hisayoshi, Takamura Masayuki, Kaneko Shuichi, Takata Shigeo, Takamura Toshinari
Department of Endocrinology and Metabolism, Kanazawa University Graduate School of Medical Sciences, Japan.
Division of Internal Medicine, Kanazawa Municipal Hospital, Japan.
Intern Med. 2019 Nov 15;58(22):3227-3234. doi: 10.2169/internalmedicine.3005-19. Epub 2019 Jul 22.
Objective We aimed to identify obstructive sleep apnea syndrome (OSAS) severity indices reflecting the anthropometric and metabolic characteristics of patients with OSAS. Methods A total of 76 patients with OSAS underwent nasal continuous positive airway pressure (nCPAP). We also investigated the effects of nCPAP on OSAS-associated muscle sympathetic nerve activity (MSNA), risk for cardiovascular diseases, and insulin secretion and sensitivity. Results Among the OSAS severity indices, HbA1c was significantly correlated with the apnea-hypopnea index, whereas HOMA-beta, HOMA-IR, and hepatic insulin resistance were significantly correlated with % SpO<90%, independent of age, gender, and body mass index (BMI). Burst incidence of MSNA was independently associated with only a 3% oxygen desaturation index. nCPAP therapy significantly lowered the OSAS severity indices and reduced the burst rate, burst incidence, and heart rate. Conclusion The OSAS severity indices reflecting apnea/hypopnea are associated with glycemic control, whereas those reflecting hypoxia, particularly % SpO<90%, are associated with hepatic insulin resistance independent of obesity. Both types of OSAS severity indices, especially the 3% oxygen desaturation index (reflecting intermittent hypoxia), are independently associated with MSNA, which is dramatically lowered with the use of nCPAP therapy. These findings may aid in interpreting each OSAS severity index and understanding the pathophysiology of OSAS in clinical settings.
目的 我们旨在确定反映阻塞性睡眠呼吸暂停综合征（OSAS）患者人体测量学和代谢特征的OSAS严重程度指标。方法 共有76例OSAS患者接受了鼻持续气道正压通气（nCPAP）治疗。我们还研究了nCPAP对OSAS相关的肌肉交感神经活动（MSNA）、心血管疾病风险以及胰岛素分泌和敏感性的影响。结果 在OSAS严重程度指标中，糖化血红蛋白（HbA1c）与呼吸暂停低通气指数显著相关，而稳态模型评估的β细胞功能指数（HOMA-β）、稳态模型评估的胰岛素抵抗指数（HOMA-IR）和肝脏胰岛素抵抗与血氧饱和度低于90%（%SpO<90%）显著相关，且不受年龄、性别和体重指数（BMI）的影响。MSNA的爆发发生率仅与3%氧饱和度下降指数独立相关。nCPAP治疗显著降低了OSAS严重程度指标，并降低了爆发频率、爆发发生率和心率。结论 反映呼吸暂停/低通气的OSAS严重程度指标与血糖控制相关，而反映缺氧的指标，尤其是%SpO<90%，与肝脏胰岛素抵抗相关，且独立于肥胖因素。这两种类型的OSAS严重程度指标，尤其是3%氧饱和度下降指数（反映间歇性缺氧），均与MSNA独立相关，使用nCPAP治疗可使其显著降低。这些发现可能有助于解释每个OSAS严重程度指标，并在临床环境中理解OSAS的病理生理学。
